Claims Workbench software for life insurers
One connected system for life insurance claims
Claims case management
Manage each claim as a single case connected to one life insured, one policy and one claim event.
Guided claims lodgement
Lodge claims from a policy or client record using a guided process that captures the event, claim contact and related policy information.
Single claims view
Bring benefits, documents, tasks, notes, provisions, payments and reviews together in one workbench.
End-to-end claims workflow
Track claims through notification, assessment, review, payment approval and closure, so teams can see where each claim sits and what needs action next.
Assess claims with policy and benefit context
Rider-level benefit assessment
Assess claimable benefits against the policy version in force on the event date, with benefits grouped by rider.
Eligibility and stand-down rules
Apply configured rules to help identify when a benefit is ineligible, such as when a claim falls inside a stand-down period.
Requirements tracking
Track required information such as medical reports, certificates and supporting documents, with controls that prevent benefits from being accepted while requirements are still outstanding.
Assessment outcomes
Record the assessor’s reasoning, benefit outcome and payment amount before sending the assessment for review.
Coordinate claims tasks, documents and reviews
Claims documents
Store supporting documents against the claims case so teams can access the material needed for assessment, review and follow-up.
Claims tasks
Create, assign and manage claim-related tasks with owners and due dates to support follow-ups and internal handoffs.
Assessment review workflow
Send completed assessments for review, creating a review task and locking the assessment until the reviewer signs off.
Review controls
Limit assessment approval to users with claims review permissions and prevent assessors from approving their own work.
Manage provisions, payments and reinsurance
Claims financials
View provisions, payments and reinsurance information in one place, so teams can understand the financial position of each claim.
Rider-level provisions
Manage amounts set aside for a claim at rider level, with audited adjustments before payment.
Claim payments
Create claim payments from approved assessments, with payment status showing whether payee details, reinsurance recovery or finance approval are still required.
Reinsurance recovery
Where configured, hold claim payments until required reinsurance recoveries have been receipted and matched.
Improve visibility and control across claims operations
Operational visibility
Use claim statuses, task queues and financial views to understand where each claim sits and what action needs to happen next.
Controlled claims handoffs
Support clearer handoffs between assessors, reviewers and finance teams through structured tasks, permissions and approval steps.
Claims audit trail
Maintain a record of important claims activity, including provision adjustments, completed reviews and closed requirements.
Claims in policy and client context
View claims in relation to policy and client records, helping teams understand the life insured, claim contact, adviser, payees and related policy context.
Modern life insurers expect more from their core systems.
Simfuni helps life insurers move faster, serve better, and stay ahead — across every part of operations.
Increase retention and reduce lapses
Proactively identify at-risk customers and prevent churn. Simfuni connects payment data, policy behaviour, and communication to help life insurers retain more policies.
Deliver exceptional customer experience
Make every interaction effortless. From payments to policy updates, Simfuni’s digital and self-service tools give policyholders confidence, control, and connection to their life insurer.
Increase efficiency and empower teams
Automate workflows and remove manual friction so teams can focus on high-value work. Happier operators deliver better outcomes at lower cost.
Launch products faster and drive innovation
Bring new products and rule changes to market in weeks, not months. With no-code flexible configuration life insurers can adapt to change quickly, test new ideas, and stay ahead of competitors.
Enable data and AI
A single, connected data foundation unlocks better insights, predictive models, and smarter automation across the policy lifecycle.
Simplify compliance and strengthen control
Stay compliant by design. Embedded rules, full audit trails, and real-time visibility make it easy to manage regulatory obligations and operate with confidence.
Adapt and grow without limits
Our API-driven architecture integrates easily with your ecosystem and scales as you grow - supporting distribution, partners, and new opportunities
An award-winning platform
