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JDi Data Claims Management & Policy Administration System Overview

Insurance Software Solutions Created With Your Success in Mind.
Power better claims management results. JDi Data suite of claims management and policy administration solutions can help turn around your claims management and workers compensation processes.

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JDi Data Claims Management & Policy Administration System Overview

  1. 1. JDi Data Corporation
  2. 2. What is JDi Data? JDi Data Corporation is a technology software provider and developer specializing instreamlined and efficient insurance claims management solutions and recentlyreleased policy administration.JDi Data Corporation has been developing software solutions for over 30 years thatstreamlines client internal management procedures, including insurance and riskmanagement-related processes that impact financial evaluations. Our decades ofinvolvement in the insurance industry has helped us build a strong repository of knowledge,analysis, data gathering, and solutions development. The foundation of our mission is todevelop and service in-house/cloud data systems for clients, associates, and corporatepartners. We take pride in fulfilling informational objectives, providing efficient data retrievalproducts, and creating intelligent, readable reports.
  3. 3. Claims Administration
  4. 4. Claims Processing – Business Rules Claims Manager® accommodates client-driven business rules which enhance workflow. Client/line of business rules may vary Different Client requirements for same LOB, No problem, change set business rules for client/LOB Work flow process and triggering mechanisms make Claims Manager® a managerial tool. Not simply a data collector, a workflow stimulator
  5. 5. Claims Manager® Main Functions1. FNOL for all lines of product. (enter new claims, retrieve using claim no. LOB, etc.)2. Bill Review (Review the claim descriptive data, eg CPT, ICD Code etc.)3. Claim Adjudication (Set reserve, settle payment, enter invoices, receive explanation of benefits , etc.)4. Payment and reconciliation of AP and AR with the carriers ERP System payee bank, payer bank, etc.
  6. 6. Claim Creation/FNOL Workflow
  7. 7. Claim Adjudication Workflow
  8. 8. Evaluation Process is OngoingBill review ensures competitivemedical ratesAlgorithms may calculate reservesbased on claim type historyKind of loss/type of loss history canassist in projecting claim valueBenefit allocation tables assist inautomationIssue automated recurringpayments, both indemnity andexpenseAlways real time, no batch updates
  9. 9. JDi Data System Architecture
  10. 10. JDi Data Development Infrastructure
  11. 11. JDi Data Development Process
  12. 12. JDi Data Production Architecture
  13. 13. System Delivery ConsiderationsWeb based SaaS model, No maintenance always up to date! Single database hosts multiple lines of business for efficiencyPolicy Admin, underwriting, rating, billing, add as needed Microsoft SQL database for use of established ad hoc reporting tools and ease of EDI hooks
  14. 14. Policy Administration
  15. 15. General Design Overview1. Clean, simple user interface to reduce the amount of user training2. Each time a policy is bound or in force, any subsequent changes are made to a “clone” of the bound policy, to preserve a strong audit trail and facilitate the claim system integration3. Bulk actions are implemented wherever possible to allow the user to perform an action on multiple items (such as generating proof of coverage letters) quickly and easily4. Strongly integrated with the claim system, uses same database.5. Permissions structure to segregate system functionality by user and/or user role
  16. 16. New/Renewal Policy Workflow
  17. 17. Policy Endorsement Workflow
  18. 18. Billing Workflow
  19. 19. Claim System Integration Traditionally, policy and claim systems rarely communicate smoothly.Adjusters often don’t have access to policy aggregates and underwriters often don’t have access to up-to-date loss runs JDi Data Claims and Policy Admin share a SQL database which facilitates very tight integration
  20. 20. JDi Data AdvantagesComplete insurance claims software solutions.We don’t offer just claims software. We offer management solutions that help you reach your businessgoals. From our Claims Manager® to our Policy Administrator software, you get the most intuitivesolutions available.Reliable, fast, and loaded with advanced features.Our solutions are the result of exhaustive research and a thorough knowledge of insurance claimssoftware needs. Each solution gives you end-to-end functionality that helps you administer, track,report, and manage your claims. • User-defined, client-dependent configuration flexibility addresses reporting parameters • AccessADoc proprietary document management. Easily access internal claim data and docs or retrieve externally stored Xerox and other document management systems. • With mail merge, generate letter templates, PDF docs, form fillers for all reporting requirements. • P&C, including Workers Compensation Software with industry standard and Custom Report Designer for simple ad hoc. Agency, broker, reinsurer, and more. Loss runs, performance, management and activity with OpticLense, functional dashboards. • Mobile device accessibility, client portal access, multiple tier access rights, audit login trail, on line help. • Integrate related software, Outlook email/calendar Plugin, T&E, HR and Accounting. • OCR technology for Google type claim data retrieval.
  21. 21. Contact Us http://www.jdidata.comJames DeRosaPresidentJames.DeRosa@JDiData.comKevin SmithNational Accounts ExecutiveKevin.Smith@JDiData.com2400 E. Commercial Blvd Suite 322Ft. Lauderdale, FL 33308954.938.9100 (phone)954.351.9838 (fax)

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