Claims Workbench
Claims management software for life insurers
Simfuni helps life insurers manage claims from notification to outcome, with assessment, review, approval, payment and recovery workflows connected in one place.
Benefits
Manage claims with more control and less coordination
Improve claims visibility
Give teams a clearer view of each claim, including requirements, assessments, reviews, approvals, payments and current status.
Reduce manual coordination
Bring claim tasks, documents, decisions and payments into one workflow, so teams spend less time managing handoffs between systems.
Strengthen approval control
Apply review and approval steps before decisions and payments move forward, supporting separation of duties and auditability.
Support a better claims experience
Help claims progress with clearer requirements, fewer manual delays and more consistent communication throughout the claim journey.
Key capabilities
Notification to outcome in one place
A claim brings together the life insured, policy and event. From lodgement, Simfuni links the relevant covers, creates requirements and tracks the case through assessment, review, payment, provisions and reinsurance.
Claims case management
Lodge a claim from the policy or client record, with the life insured, contact, event and assessor details kept together.
Notification to outcome workflow
Track the claim through lodgement, assessment, review, approval, payment and close.
Reviews and approvals
Assessments go through a review step by a second person, and payments need two finance approvers, so decisions and money both get a four-eyes check.
Claims payment automation
Approved assessments create a payment per payee, split by share, ready for finance approval and processing.
Reinsurance recoveries
Where a benefit requires reinsurance recovery, the claim payment can wait in an awaiting recovery state until the recovery is received.
Benefit-level rules
Drive requirements, eligibility, outcomes and documents from the benefit configuration, so the right checks apply automatically.
How it works
Control every claim from first notification to closure
Assessment with the right checks built in
Each benefit is assessed against the policy wording, claim requirements and assessor reasoning. Requirements must be met before a benefit is accepted, and ongoing claims, reserves and paid periods stay visible throughout the assessment.
- Outcomes per benefit: pending, accepted, ineligible or ex gratia
- Requirements must be met before a benefit is accepted
- Ongoing disability claims assessed and paid period by period
- Reserves tracked against each benefit and reflected in finance
