Claims Management
Structured intake, automated workflows, and real-time status tracking from the moment a loss is reported to the day the claim closes.
An insurance policy is a promise. A claim is the moment that promise is tested. For independent agencies, the claims process is often the single most important touchpoint in a client relationship — and yet it is frequently the most disorganized. Claims arrive via phone, email, text, and walk-in. Details get recorded on sticky notes or in email drafts. Status updates require calling the carrier and waiting on hold. Clients call back asking "what's happening with my claim?" and the CSR has to scramble to piece together an answer from fragments scattered across three systems.
PrizMova's insurance claims management software replaces that chaos with a structured, trackable, and automated workflow that handles every claim from first notice of loss through final resolution. Every claim lives in one place, linked to the relevant policy and client profile, with a clear status, assigned handler, and complete document trail. Your team always knows where a claim stands, and so do your clients.
The First Notice of Loss is the most critical moment in the claims process. Information captured during FNOL directly impacts how quickly and accurately the claim is processed. PrizMova provides a structured FNOL intake form that adapts based on the type of loss — an auto accident collects different details than a water damage event or a general liability incident.
When a CSR begins the FNOL process, PrizMova pre-populates the client's information, active policies, and coverage details. The CSR focuses on capturing the loss-specific facts: date and time of loss, location, description of what happened, involved parties, witnesses, police report numbers, and initial damage assessment. Photos and documents can be uploaded directly during intake or added later via a secure client-facing upload link that PrizMova generates automatically.
Once the FNOL is submitted, PrizMova automatically identifies the applicable policy, verifies that the loss falls within the coverage period, checks the deductible amount, and creates a claim record with a unique claim number. The carrier is notified through the appropriate channel, and a confirmation is sent to the client with their claim number and the name of the person handling their file. All of this happens in minutes, not hours.
Every claim in PrizMova moves through a defined set of stages: Reported, Acknowledged, Under Investigation, Pending Documentation, Under Review, Approved, Denied, Paid, Closed, and Reopened. Each status transition is logged with a timestamp and the user who triggered it. Automated notifications fire when a claim enters a new stage, keeping the client informed without requiring your team to send manual updates. Stale claims that have not progressed within configurable time thresholds trigger escalation alerts to supervisors.
Many claims require third-party vendors — restoration companies, independent adjusters, auto body shops, contractors, or forensic accountants. PrizMova maintains a vendor directory organized by specialty, geography, and performance rating. When a claim requires vendor involvement, the handler selects from pre-approved vendors, and PrizMova generates an assignment notification with the claim details, scope of work, and contact information. Vendor invoices and reports are attached directly to the claim record, creating a complete paper trail.
Claims generate more documentation than any other agency workflow: loss reports, police reports, medical records, repair estimates, photos, adjuster reports, subrogation correspondence, and settlement agreements. PrizMova organizes all claim documents in a structured hierarchy within the claim record. The secure client upload link lets insureds submit photos and documents from their phone without needing an account or app — files go directly to the correct claim file with automatic virus scanning and format validation.
Accurate reserve tracking is essential for both agency management and carrier relationships. PrizMova records initial reserve amounts set by the carrier or adjuster and tracks every adjustment over the life of the claim. When a reserve changes — whether due to new damage discovery, supplemental estimates, or partial payments — the update is logged with the reason, the previous amount, and the new amount. Agency principals can view aggregate reserve exposure across their entire book, filtered by carrier, line of business, or date range.
Payment tracking follows the same structured approach. As partial payments, advance payments, and final settlements are issued, PrizMova records each transaction against the claim with the payee, amount, date, and check or EFT reference number. When the claim closes, the full financial history is available in a single view: total incurred, total paid, deductible applied, subrogation recovered, and net claim cost. This level of financial visibility is critical for agencies that participate in contingency or profit-sharing arrangements with carriers.
When a hurricane, wildfire, hailstorm, or flood event strikes, agencies face a unique and overwhelming challenge: hundreds or thousands of clients may be affected simultaneously. Traditional claims processes collapse under this volume. Phones ring nonstop, email inboxes overflow, and there is no systematic way to identify which clients are in the affected area or what policies they hold.
PrizMova's CAT Commander is purpose-built for catastrophe events. When a CAT event is declared, the system cross-references the event geography against your client database and identifies every policy with a property, auto, or commercial location in the affected zone. Within minutes, you have a complete list of potentially impacted clients with their policy details, coverage limits, deductibles, and contact information.
From that list, CAT Commander enables mass notifications — personalized emails or SMS messages sent to affected clients with instructions on how to file a claim, what to document, and who to contact. As FNOL reports come in from the event, they are automatically tagged with the CAT event identifier, enabling the agency to track catastrophe-related claims separately from normal operations. Carrier reporting, which typically requires hours of manual compilation after a CAT event, is generated automatically with affected policy counts, estimated exposure, and filed claim totals.
In a legacy AMS, claims are often an afterthought — a screen where you record a claim number and a date, then track everything else in email and spreadsheets. PrizMova treats claims as the high-stakes, relationship-defining events they actually are. Every step is guided, every deadline is tracked, every document is organized, and every communication is logged. The agency that handles a claim well earns a client for life. The agency that drops the ball loses not just one client but every referral that client would have made. PrizMova's insurance claims management software ensures your agency is always the former, never the latter.
Related Features
Claims link directly to the underlying policy for instant coverage verification, deductible lookup, and carrier contact details — no switching between modules.
Claim documents, photos, adjuster reports, and settlement agreements are automatically organized and linked to both the claim and the client profile.
Track claims frequency, severity, loss ratios by carrier, and CAT event impact across your book with real-time dashboards and exportable reports.