OneSumX NILS for Claims Compliance
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OneSumX NILS for Claims Compliance

  • In the US, 3 Out Of 10 Regulator Criticisms Are Claims Related - Juggling Claims Costs and Consumer Expectations without Dropping the Ball on Compliance is Tough To Do

    Every day, Claims departments must balance the need for compliance with the business needs of prompt, accurate claims processing and cost control. Compliance failures in claims processes are not only on the top of regulators' priorities, but also are quick to get the attention of media and consumers. Extensive regulation and resource limitations make communication of and control over compliance a difficult to achieve goal. In this high pressure environment organizations must ensure that compliance is built-in to the process as much as possible to reduce compliance risks and achieve business goals.

    With point solutions designed to interact when needed, organizations can achieve the results they need while being supported by experts they trust to get it right. By bringing content, technology and expertise together, we help organizations effectively communicate, monitor and report on compliance across the organization to in order to provide the most compelling evidence for external concerns and internal strategic decision-making. Wolters Kluwer’s claims compliance solution provides all the components needed to successfully juggle the diverse needs of claims processing while optimizing compliance and controlling risk.

      • Claims Regulatory Intelligence from the most trusted and relied upon source – OneSumX NILS INsource. Optimized for use by insurance professionals, OneSumX NILS INsource is the leading web-based insurance regulatory content source. With unique indexing and functional area categories, Claims staff can easily obtain the regulatory content they need, significantly reducing research time and increasing the effectiveness of compliance efforts.
      • Market Conduct Research helps Claims staff understand what regulators are focusing on and what they are criticizing in examinations. Last year, 3 of the top 10 most criticized areas overall in market conduct examinations were claims-related. Insurers can reduce or eliminate fines in future market conduct examinations by researching past market conduct examinations in their own and other jurisdictions, identifying the areas of greatest concern to examiners, and addressing their areas of possible non-compliance.
      • Configurable Regulatory Change management and insightful reporting provides the management tools necessary to ensure an efficient regulatory change implementation and compliance with requirements in an ever-changing regulatory environment, and keep staff informed of changes automatically.
      • Policies and Procedures are the backbone of a claims compliance program and solve the problem of centralizing and automating claims manuals. OneSumX Policies and Procedures is available as a point solution to help organizations automate and manage policies and procedures and demonstrate compliance with requirements, ensuring that all staff has access to current policies and can demonstrate an understanding of what is required. Optional prebuilt libraries for Claims save time by providing a starting set of policies and procedures in compliance with mandated requirements.
      • Operational Compliance is easier to achieve when claims staff have access to easy-to-understand summaries of complex regulatory requirements and required forms when they are processing claims. OneSumX NILS Claims provides desktop access to more than 9,000 summaries of 25,000+ regulations impacting claims, and more than 1,250 forms that are used in processing claims.