Expert Insured joins the Selectsys Family of Solutions for MGAs, MGUs, Wholesalers, and Carriers Read the Press Release

Overview

Claims Workflow and Statuses gives teams a consistent, configurable way to move every claim from FNOL to closure with clear milestones, ownership, and controls. It is the operational backbone for timely decisions, audit-ready tracking, and leakage prevention across programs and lines.

Built as part of Claims Tracking, it helps MGAs, MGUs, wholesalers, and carriers coordinate work, align with TPAs, and meet service commitments. Expert Insured unifies claims operations within an insurance operations platform that supports complex programs and distribution channels.

Why it Matters

  • Accelerates cycle time by standardizing handoffs, SLAs, and escalation paths.
  • Reduces leakage through required approvals, reserve gates, and documented decisions.
  • Improves compliance with an auditable status history and consistent procedures.
  • Enhances partner coordination with synchronized statuses across TPAs and carriers.

Who it is For

How it Works

  • Configurable status models by program and line of business with reusable templates.
  • SLA timers, reminders, and escalation rules that drive on-time handling.
  • Assignment and queue routing rules for intake, triage, investigation, and recovery.
  • Real-time TPA and carrier synchronization using TPA Integrations.
  • In-line documentation and evidence capture at each milestone via Adjuster Notes and Documentation.
  • Reserve checkpoints and approval workflows tied to status changes using Reserve Tracking.
  • Bottleneck and cycle time reporting with Claims Analytics and Dashboards.
  • Automated loss run readiness and distribution triggered by status outcomes through Loss Run Generation and Sending and policy linkages in Policy Management.

Why Expert Insured is Best for Claims Workflow and Statuses

Expert Insured combines flexible workflow design with strict governance, so you can tailor statuses by program while enforcing approvals, SLAs, and audit trails. As an agency management system and broader insurance management platform, it connects claims to policies, reserves, analytics, and partner integrations in one place. You get no-code configuration, granular permissions, and analytics that surface delays and leakage risk without custom projects.

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Frequently Asked Questions

Yes. You can define status taxonomies per program and LOB, then apply templates to new programs for consistency. Statuses can reference policy terms and endorsements managed in Policy Management to keep context aligned.

Use TPA Integrations to exchange status updates, notes, and key dates. You can map external codes to your internal model and set reconciliation rules to prevent mismatches.

Yes. You can set SLA timers on statuses, trigger reminders, and auto-escalate to supervisors. Performance against SLAs is available in Claims Analytics and Dashboards.

Each status can require specific artifacts and checkpoints. Adjusters can upload files, add commentary, and tag participants using Adjuster Notes and Documentation.

They can. Reserve thresholds and approval steps can be tied to status transitions and governed in Reserve Tracking to reduce leakage and maintain auditability.

Dashboards in Claims Analytics and Dashboards surface time-in-status, queue backlogs, and exception trends. You can also generate stakeholder-ready summaries through Loss Run Generation and Sending.

Yes. Claim files are linked to policy details, endorsements, and contacts maintained in Policy Management, so adjusters have the needed context at each step.

Expert Insured supports AI-driven recommendations that can align with your workflows. See available options in AI Solutions to augment triage, routing, and document review.