What All Claims Organizations Need to Understand About APIs

In the world of claims management, a high-quality claims management solution (CMS) can make a powerful difference by helping to streamline key processes and empowering claims adjusters to optimize their performance. But providing those benefits doesn’t require a CMS to take care of all key digital processes related to claims management on its own.

In fact, the ability to work well with other digital technologies is a critical part of making a CMS user-friendly, flexible, and efficient for claims departments.

For today’s claims software, one key to making that happen is offering a robust set of APIs. That’s why Five Sigma’s API framework is such an integral part of our claims technology.

Why are APIs such a powerful asset for a CMS? This blog post will answer that question in light of the variety of processes involved in managing insurance claims. But first, we need to look at what APIs are and the role that they play in contemporary software development.

What is an API, and why can it be so useful for claims management?

An API (application programming interface) is a part of a software application that allows it to communicate directly with other applications. By enabling applications to send and receive data to and from each other, APIs offer programmers an efficient way to build complex, high-quality programs. Simply put, APIs allow developers to build new products without “reinventing the wheel.”

Over time, APIs have taken on a central role in software development. Today, they are an essential part of the internet and popular programs.

For consumers, APIs can allow for a user experience that brings together various best-in-class technologies, including microservices. That’s because APIs allow programmers to focus on developing a core product of the highest quality, while tapping into the power of existing solutions to add a wide variety of peripheral capabilities.

While we may not always be aware of how dependent we are on APIs, virtually all of us rely on them in our daily lives. For example, when websites or mobile apps present us with maps, convenient ways to get in touch, or social media integrations, they often use APIs to streamline communication between software programs.

What are the main types of APIs for claims compamies?

Today’s software uses many APIs, which can be grouped based both on their architecture and on which applications they are allowed to interact with.

When programmers develop APIs, there are four different approaches they can use to determine which other software they will be able to communicate with. As a result, APIs can be categorized as:

  • Internal (or private) APIs. Taking the most restrictive approach to working with other apps, internal APIs are only visible to users within a given company. They are intended to streamline communication across various teams.
  • Partner APIs. Taking a somewhat more flexible approach to working with other software, partner APIs are available to specified external companies. Still, they are only able to interact with applications belonging to strategic partners and are not publicly accessible.
  • Open (or public) APIs. Of all APIs, these are the most flexible in terms of which applications they can work with. They are available to the public at large, allowing other programmers to use them on an open-source basis.
  • Composite APIs. For more complex needs, programmers may rely on a composite API, which combines multiple other APIs to bring together data from various sources.

Why are APIs critical for streamlined claims management?

Not only do APIs offer developers a streamlined approach to building software, but they can allow users to work seamlessly with multiple integrated solutions. This is particularly important within a CMS, because it allows new customers to keep using the third-party services they already rely on. APIs also allow insurance providers to add new third-party capabilities without facing the kinds of difficulties that can result from information silos.

And the benefits that APIs can offer claims departments go well beyond a seamless user experience. APIs can also empower them to optimize claims management processes, improve risk assessment capabilities, deliver a superior experience to their customers, and drive business growth.

The specific benefits that APIs can provide to claims departments include:

  • Reduced loss adjustment expense (LAE). By making it easy to use third-party solutions in order to streamline processes, APIs can help insurers reduce their claim cycle times, improve their efficiency, and cut costs.
  • Enhanced risk assessment. By enabling insurers to access policy and claims data in real time, APIs can allow for a more efficient and reliable evaluation of risk. By saving time, this can accelerate claims processing and improve the customer experience for claimants.
  • Increased customer satisfaction. In addition to reducing claim cycle times, APIs can provide claimants with a convenient, personalized experience in which they submit and access their claims via the channel of their choice.
  • Business growth. By leveraging API-enabled partnerships, claims organizations can tap into new opportunities, enhance their overall service, and drive growth.

What can Five Sigma’s APIs do for claims departments?

To help our clients streamline and enhance their claims management, Five Sigma offers a wide range of APIs (as well as webhooks) that can help them work effectively with both claimants and partners along the entire claims lifecycle.

Specifically, Five Sigma’s CMS includes:

  • FNOL APIs, which can automatically pull data from any FNOL app or website – allowing insurers to let their policyholders file a claim via any digital channel.
  • Policy APIs, which can integrate with any policy admin software to pull policy holder information, allowing for quick and easy coverage verification.
  • Claims APIs, which can quickly retrieve claim, exposure, or policy data needed in order to process a claim.
  • Vendor APIs, which can assign claims to third-party service providers and get status updates.
  • Payment APIs, which can automate payment processing and make payments using any payment method.
  • Webhooks, which can automatically send and receive real-time status updates regarding key steps taken in processing a given claim.

Conclusions on APIs for Claims Organizations

While APIs are used widely across a range of digital products, claims departments are particularly well suited to realize their benefits. APIs offer a powerful and efficient way for digital platforms to interact. And given that managing claims effectively requires performing a variety of processes and handling a variety of data, APIs can help claims departments to streamline and accelerate their core processes.

As a result, a robust API offering can give a serious boost to a claims management solution’s overall usefulness for claims organizations. By tapping into the power of a set of APIs like Five Sigma’s, a CMS can offer insurance carriers major benefits, such as cutting LAE, improving risk assessment, boosting customer satisfaction, and driving business growth.

To see for yourself how Five Sigma’s API-rich claims technology can help you streamline and enhance your claims management, request a demo.



Why are APIs such a critical part of Five Sigma’s claims management technology?

Recognizing the importance of efficiency for claims departments, we at Five Sigma have bolstered our claims management technology with an industry-leading set of APIs. This way, when companies start using our platform, they can continue using a range of third-party services they may already be using. And as they continue using our technology, they can add more third-party services and integrate them seamlessly.

What are some of Five Sigma’s key third-party integrations and APIs?

Five Sigma’s robust range of APIs covers every aspect of the claims lifecycle, making it easy for our clients to integrate their claims platform with a variety of third-party services. These include FNOL APIs, policy APIs, claims APIs, vendor APIs, payment APIs, and data export APIs. We also offer webhooks, as well as integrations with services offered by our partners.

How can Five Sigma’s APIs reduce loss adjustment expense (LAE)?

It’s all about simplifying and streamlining claims management. Not only is our core offering built from the ground up to make claims management as efficient and reliable as possible, but our APIs supplement it by allowing our clients to combine our technology seamlessly with other services they rely on. This way, claims adjusters can work quickly and efficiently, without wasting time dealing with siloed systems. By saving claims departments serious time, this approach can save them serious money.

Five Sigma - AI-Native Claims Management Platform

Five Sigma offers an AI-native claims management platform that streamlines every step of the claims process. With full visibility of the claim at a single place, advanced automation, and data-driven insights, Five Sigma empowers adjusters to excel, speeding up claims handling and improving policyholder satisfaction. Adjusters are freed to focus on decision-making and customer service. 

For insurers, MGAs and TPAs, Five Sigma is a risk-free solution that unlocks unprecedented benefits quickly. Insurers gain unparalleled visibility into their claims and operations. The result is a significant reduction in Loss Adjustment Expenses. Five Sigma is a future-proof platform that is always up to date for the benefit of all its customers and gives insurers the agility to handle any claim faster, add new Lines of Business in less than a day, and accommodate new business models easily, enabling you to adapt swiftly to market changes ahead of the competition.

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