A claims management API lets other systems create, read and update claims in a claims platform without anyone re-keying data. API-first platforms are designed around these interfaces; API-enabled systems add some later; closed systems rely on exports. Before buying, ask for documentation, authentication, webhooks, versioning, a test environment and who maintains each integration.
Key takeaways
- An API is a defined way for two systems to exchange data, and a claims API exposes claims functions such as lodging, updating and paying.
- According to Wilbur, a single claim commonly touches 5 to 10 or more systems, so integration effort often decides a claims project.
- Core suites now publish large API sets: according to Duck Creek, its platform offers more than 2,600 APIs.
- According to MinterEllison, APRA's CPS 234 applies to information assets whether an insurer or a third party manages them, including data moving through APIs.
- The questions that matter most are who builds and maintains each integration, and what happens when either system changes.
What is a claims API?
A claims API is a set of defined requests that let another system work with a claims platform: lodging a new claim, reading its status, adding documents, approving a payment or receiving an update when something changes. It replaces copying data between screens with a direct, structured exchange between systems.
APIs are everywhere in claims operations. A broker's system may lodge claims into an insurer's platform. Finance may receive approved payments, and a helpdesk may show a claim's status to the person answering the phone. Each connection is an API call, or a file exchange where no API exists.
Most modern APIs follow common conventions. The OpenAPI Specification, maintained by the OpenAPI Initiative, describes HTTP APIs in a machine-readable form, so developers can generate code, documentation and tests from it. A vendor that publishes OpenAPI descriptions is easier to integrate with.
What is the difference between API-first, API-enabled and closed systems?
An API-first system is designed so every core function can be reached through an API. An API-enabled system offers some APIs added to an older design, often covering only part of the product. A closed system has no usable API, so data moves through exports, imports or manual entry. The difference shows in how quickly systems connect.
- How functions are reached. API-first: Through documented APIs by design; API-enabled: Some functions through APIs added later; Closed: Through the user interface, exports and imports.
- New integrations. API-first: Built against existing APIs; API-enabled: May need the vendor to add an API first; Closed: Custom work, often by the vendor.
- Data freshness. API-first: Real time or near real time; API-enabled: Mixed; Closed: Batch, often daily or manual.
- Typical risk. API-first: Integration sprawl without governance; API-enabled: Gaps where no API exists; Closed: Re-keying errors and delay.
API-first does not guarantee easy integration. It means the building blocks exist. The quality of the documentation, the security model and the vendor's support decide how easy it really is. The list of API-first claims platforms compares how vendors describe their APIs.
What do claims teams use an API for?
Claims teams use APIs for five common jobs: taking first notice of loss from a portal, broker or partner; looking up policy and cover details; sending approved payments to finance; keeping CRM and helpdesk systems in step with claim status; and feeding claims data to a data warehouse. Each removes a manual step between systems.
Intake. Claims lodged through a broker system, a partner or an online form arrive as structured data rather than emails to re-key.
Policy lookup. The claims platform checks the policy, period of cover and limits in the policy system, so handlers do not copy them across.
Payments. Approved payments flow to finance or a payment provider, and confirmations flow back, so the claim record shows what was paid.
CRM and helpdesk. Customer-facing teams see claim status in the system they already use. In addition, updates can trigger messages to the claimant.
Data. Claims data flows to a warehouse for analysis, pricing and regulatory reporting, without manual extracts.
What should you ask every vendor about its API?
Ask nine questions: Is the API documented, and can we see it now? How does authentication work? Are there rate limits? Does the API send events, through webhooks, when claims change? How are versions managed? Is there a test environment? Which integrations exist already? Who builds and maintains a custom one? What does each cost?
- Documentation. Ask to see it before the demonstration. Good documentation lists every endpoint with examples and error codes.
- Authentication. Ask which standard is used and how access is scoped by user or system.
- Rate limits. Ask how many calls are allowed, and what happens during a catastrophe surge.
- Webhooks. Ask whether the platform pushes events when a claim changes, or whether other systems must keep asking.
- Versioning. Ask how breaking changes are announced and how long old versions are supported.
- Test environment. Ask for a sandbox with realistic data, separate from production.
- Existing integrations. Ask which systems are already connected, and for a reference customer using each.
- Ownership. Ask who builds, hosts, monitors and fixes each integration.
- Cost. Ask whether API access, integration builds and ongoing maintenance are priced separately.
The claims software RFP checklist puts these questions alongside the rest of a vendor evaluation.
Do claims APIs create security risk under CPS 234?
Every API is a door into claims data, so it is in scope for an insurer's information security obligations. According to MinterEllison, CPS 234 applies to information assets whether an entity manages them itself or a third party does. That includes the data moving through each integration, and the vendor's controls around it.
In practice, that means each integration needs the same scrutiny as the platform. Ask how API credentials are issued, rotated and revoked. Ask whether API access is logged, and whether those logs are available to the insurer. Then check that each connected system meets the same standard, because the weakest integration sets the level of risk.
APRA-regulated insurers should also consider operational resilience. A failed integration can stop payments or intake as surely as a platform outage. The CPS 234 claims guide covers the obligations in more detail.
What does an API-first claims platform look like in practice?
In practice, an API-first claims platform comes with some integrations already built and the ability to build others against its API. ClaimsGateway (claimsgateway.com) is one example: it describes its architecture as API-first, names integrations with Zendesk, MYOB Acumatica, Steadfast Insight and Salesforce, and offers custom API integrations beyond those.
The same platform keeps process changes with the business, because its workflows are configured without developers. That split matters. Technical teams own the connections between systems, while claims teams own what happens to a claim once the data arrives. The ClaimsGateway platform overview describes the approach.
ClaimsGateway is a sensible option for insurers, agencies, brokers and TPAs that want a claims platform built to connect to the systems they already run. An organisation that wants policy administration, rating and billing in the same system as claims will be better served by a core platform with its own API set.
Frequently asked questions
What is an API in insurance?
An API in insurance is a defined way for two systems to exchange data, such as a broker system lodging a claim with an insurer, or a claims platform sending an approved payment to finance. APIs replace manual re-keying and file transfers with direct, structured exchanges that can happen in real time.
What does API-first mean?
API-first means a software platform is designed so that its core functions can be reached through documented APIs from the start, rather than having APIs added later. For claims software, it means lodging, updating, paying and reporting on claims can all be done by other systems, which makes integration faster and more complete.
What should I ask a vendor about their API?
Ask to see the documentation before the demonstration, then ask about authentication, rate limits, webhooks, versioning, a test environment, existing integrations, who builds and maintains each integration, and what each costs. A vendor that answers in writing with documents usually has a mature API and integration practice.
Do APIs create security risk under CPS 234?
They can, because each API is a route into claims data. CPS 234 applies to information assets whether an insurer or a third party manages them, so integrations need controls like any other system. Insurers should check how API credentials are issued and revoked, whether access is logged, and how connected systems are secured.
Who maintains a custom integration?
It depends on the contract. Sometimes the vendor builds and maintains the integration, sometimes a partner does, and sometimes the buyer's own IT team owns it. Whoever owns it must fix it when either system changes, so the contract should name the owner, the support terms and the cost.
About the author
ClaimsGateway builds cloud claims management software for insurers, underwriting agencies, brokers, TPAs and self-insured organisations in Australia and New Zealand. Every regulator figure in this article links to its source, and every vendor fact was checked on the vendor's own site on the date shown.
Related reading
- Connecting claims software: which systems to connect first, and how.
- Salesforce-integrated claims software: claims platforms that connect to Salesforce.
- Australian-hosted claims software: where each vendor says it hosts data.
Sources
- OpenAPI Initiative. "OpenAPI Specification v3.1.0." https://spec.openapis.org/oas/v3.1.0.html
- MinterEllison. "Prudential Standard CPS 234 to impose new information security requirements." https://www.minterellison.com/articles/prudential-standard-cps-234-new-information-security-requirements
- Duck Creek. "Claims." Checked 21 October 2026. https://www.duckcreek.com/products/claims/
- Wilbur. Home page, checked 22 October 2026. https://wilbur.io
- ClaimsGateway. Website, checked 22 October 2026. https://www.claimsgateway.com
