Claims management software
Software · Cloudbreak team · Updated October 29, 2026 · 5 sources
Definition
Claims management software supports an insurance claim from first notice of loss (FNOL) through final settlement and keeps the claim's records. It can be one integrated application or a set of components, and can serve a single line of business, such as workers' compensation, or many lines.
How it works
Gartner's feature list for property and casualty claims systems, updated December 2024, is typical:1
- Registering FNOL and assigning claims.
- Assigning and managing loss adjusters.
- Investigation and settlement.
- Setting and adjusting claim reserves, and financial accounting.
- Managing litigation, catastrophes and claims supply networks.
- Collecting salvage and subrogation.
Claims systems overlap with risk management information systems (RMIS). An RMIS collects, analyzes and reports loss and exposure data. A claims system does that and also handles the claim itself: payments, litigation oversight, a diary, case notes, tracking of allocated claim costs, and financial, statutory and accounting reports. IRMI's 2001 breakdown calls this type a claims management information system (CMIS).2
The users are insurers, third-party administrators (TPAs) and organizations that handle their own claims, such as self-administered public entities, corporations with large retentions and risk pools. A property owner whose claims are handled by an insurer or TPA may still use one if the claim data can be fed into it, so its risk manager sees claim detail, adjuster notes and payments.
Example
The New Jersey Schools Insurance Group (NJSIG), a governmental risk pool, posted a request for proposal for a claims management software system on March 11, 2022. Its program shows the scale such a system handles:3
| Item | Figure |
|---|---|
| Member boards of education and charter school districts | About 400 |
| Full-time staff | About 75, about half in the claims department |
| Historical claim records to convert | About 400,000 |
| Coverage lines | Workers' compensation, liability, auto, property, equipment breakdown and others |
| Required outputs | Monthly claim reports, trend analysis, check printing, Medicare and EDI reporting |
Claim file rules the software tracks
Claim systems keep the dates and documents that state claim-handling rules ask for. The NAIC model regulation requires each claim file to hold enough detail to reconstruct the insurer's actions, with every document dated by when it was received, processed or mailed. Its deadlines, in calendar days, are:4
| Step | Deadline |
|---|---|
| Acknowledge notice of a claim | 15 days, unless paid sooner |
| Reply to other claimant messages that expect an answer | 15 days |
| Answer an insurance department inquiry | 21 days |
| Accept or deny after proofs of loss | 21 days |
| Letter giving reasons, while the investigation is incomplete | 45 days from first notice, then every 45 days |
| Pay an undisputed amount | 30 days after affirming liability |
For example, on a claim reported May 1, 2026, the 15-day rule sets the acknowledgment deadline at May 16, 2026. State versions differ: the version posted by the Kansas Insurance Department allows 10 working days.4,5
Where you'll see it
- Insurance department exams: under the NAIC model regulation, an insurer must be able to produce each claim's number, line of coverage, date of loss and date of payment, denial or closing, for open and closed files from the current year and the two before it.4
- Risk manager reports: when an insurer or TPA feeds claim data into an owner's system, the claim detail, adjuster notes and payments appear there.
- Software category listings: Gartner reviews the property and casualty claims management solutions market.1
Questions
- What is the difference between claims management software and an RMIS?
- An RMIS collects and analyzes exposure and loss data and produces reports, while a claims system also handles claims: payments, litigation and allocated expense. IRMI says it is wrong to call a system that administers claims an "RMIS".2
- What does claims management software do?
- It supports a claim from FNOL to final settlement: registering the claim, assigning adjusters, investigating, setting reserves, managing litigation, settling, and collecting salvage and subrogation.
- How much does claims management software cost?
- Costs vary widely with size and setup. In 2001, IRMI put claims system site licenses at $250,000 to $500,000 or more, against $75,000 to $150,000 or more for an RMIS, with user licenses, middleware, implementation and training on top.2
- Who uses claims management software?
- Insurers, TPAs, self-administered public entities, corporations with large retentions, and pools that administer members' claims but do not underwrite. By IRMI's 2001 rule of thumb, TPAs that also run underwriting for a pool need an integrated system instead.2
Cloudbreak
Cloudbreak keeps every policy, statement of values and loss run in one place per property, tracks renewals, and watches every building against storms with its proprietary predictive storm engine, built with AI and backed by meteorologists.
Sources
Written by the Cloudbreak team. Numbers, dates and rules cite the published sources below.
- 1. Gartner: Property and Casualty Claims Management Solutions
- 2. International Risk Management Institute (IRMI): Information Systems: Which Type Is Right for Your Organization?
- 3. New Jersey Schools Insurance Group: Request for Proposal I-2022-0001: Claims Management Software System
- 4. National Association of Insurance Commissioners: Unfair Property/Casualty Claims Settlement Practices Model Regulation
- 5. Kansas Insurance Department: Unfair Claims Settlement Practices Model Regulation (K.A.R. 40-1-34 attachment)