A claims platform has to exchange data with the policy system, finance, CRM, helpdesk, broker systems and the data warehouse. Connect policy lookup and payments first, because they remove the most re-keying. Use real-time APIs where timing matters and scheduled files where it does not. Before buying, settle who builds, maintains and pays for each integration.
Key takeaways
- The first two integrations to build are usually policy lookup and payments, because both remove manual re-keying on every claim.
- According to Wilbur, a single claim commonly touches 5 to 10 or more systems, which is why integration planning matters before purchase.
- You do not need to replace your core system to change claims software, provided the two can exchange data.
- According to Norton Rose Fulbright, CPS 230 makes claims management a default material service for insurers, which can bring integration partners into scope.
- Every integration needs an owner who fixes it when either system changes.
Which systems does a claims platform have to talk to?
A claims platform usually talks to six systems: policy administration for cover and limits, finance for payments and reconciliation, CRM for the customer relationship, the helpdesk for enquiries, broker systems for lodgement and status, and a data warehouse for reporting. Each exchange moves specific data in one or both directions.
- Policy administration. What flows to claims: Policy, cover, limits, excess, insured details; What flows from claims: Claim notifications, reserves and claim history.
- Finance and payments. What flows to claims: Payment confirmations, bank details checks; What flows from claims: Approved payments, recoveries, reconciliation data.
- CRM. What flows to claims: Customer and account details; What flows from claims: Claim status and history on the customer record.
- Helpdesk. What flows to claims: Enquiries and tickets from claimants; What flows from claims: Status and next steps for whoever answers.
- Broker systems. What flows to claims: Claim lodgements and updates; What flows from claims: Status and decisions for the broker's client.
- Data warehouse. What flows to claims: Nothing, usually; What flows from claims: Claims data for analysis, pricing and reporting.
Not every organisation needs all six. A small agency may need only policy lookup and payments. A large insurer, however, may connect all of them and more, such as repairer networks and fraud data providers.
Which integration patterns suit claims software?
Three patterns cover most claims integrations: real-time APIs, scheduled file exchange and embedded views. Real-time APIs suit anything a handler waits for, such as a policy lookup. Scheduled files suit bulk data that can wait, such as a nightly feed to the warehouse. Embedded views show one system's data inside another's screen.
Real-time API. One system calls the other as an event happens, and gets an answer in seconds. It suits policy checks at first notice of loss and payment confirmations. The guide to claims APIs explains what to ask a vendor about its API.
Scheduled file. Data is exported and imported on a timetable, often nightly. It is simpler to build and suits reporting, bordereaux and bulk updates. Its weakness is delay, because nothing moves between runs.
Embedded view. A panel in one system shows data from another, such as claim status inside the CRM. It avoids copying data at all, though it depends on both systems supporting the approach.
What should you integrate first?
Integrate policy lookup and payments first. Policy lookup removes re-keying at every first notice of loss and reduces cover errors. Payments remove re-keying at every settlement and keep the claim record and the ledger in step. CRM, helpdesk and warehouse connections add value, but they can usually follow once claims are running.
The order follows the money and the risk. A wrong policy detail can lead to a wrong decision, and a wrong payment detail can send money to the wrong account. Both are costly to unwind, so automating them early pays back quickly.
Payments are also where the claims platform itself can do more of the work. ClaimsGateway (claimsgateway.com), for example, builds automated payment set-up, tracking and reconciliation into the platform through an integrated payment system. That reduces how much needs to be built between claims and finance.
The rest can follow in order of pain. If staff spend hours answering status calls, the helpdesk link comes next. If finance struggles with month-end, the ledger feed does.
Do you need to replace your core system to change claims software?
No. A claims platform can run beside an existing policy or core system, provided the two can exchange the data claims needs: policy details in, claim and payment data back. Many insurers and agencies change claims software without touching their core, which makes the project smaller and less risky than a suite replacement.
The trade-off is the integration itself. Two systems need to agree on what a policy, a claim and a payment look like, and stay in step. The core module or claims platform sets out when each route makes more sense.
Regulation adds a layer for insurers. According to Norton Rose Fulbright, insurers must classify claims management providers as material service providers under CPS 230 by default. An integration partner that keeps claims running may need the same due diligence and contract terms.
What should you settle before you buy?
Settle four things in writing: who builds each integration, who maintains it, what happens when either system upgrades, and what each costs to build and to run. These answers decide the real cost and risk of a claims platform more than its feature list does, and they are hardest to change after signing.
Ownership comes first. For each integration, the contract should name whether the vendor, a partner or your own IT team builds it and fixes it. Next, ask how the vendor announces changes to its API, and how long older versions keep working.
Cost comes last but matters most over time. Integration builds are often a one-off fee, while maintenance is ongoing. So ask for both, per integration, before comparing quotes. The claims software RFP checklist includes these questions.
What does this look like with a specific platform?
With a specific platform, the integration plan starts from what is already built. ClaimsGateway, for example, names integrations with Zendesk, MYOB Acumatica, Steadfast Insight and Salesforce, plus custom API integrations, and describes its architecture as API-first. A buyer would check which of its own systems are on that list and scope the rest as custom work.
The ClaimsGateway platform overview describes the approach. ClaimsGateway suits insurers, agencies, brokers and TPAs that want a claims platform beside their existing systems. An organisation replacing policy, billing and claims in one programme, however, will be better served by a core suite with its integrations built in.
Frequently asked questions
What should claims software integrate with?
Claims software usually integrates with the policy administration system for cover and limits, finance for payments and reconciliation, the CRM and helpdesk for customer contact, broker systems for lodgement and status, and a data warehouse for reporting. Most organisations start with policy lookup and payments, then add the rest.
Do I need to replace my core system to change claims software?
No. A claims platform can run beside an existing core or policy system, as long as the two can exchange policy, claim and payment data. That makes a claims change smaller than a full core replacement. The integration between them needs a clear owner and good testing.
How long does a claims integration take?
It depends on the systems, the data and the pattern. A connection to a system the vendor has already integrated with is usually quicker than a custom build. Real-time APIs take longer to build than scheduled file exchanges. Ask each vendor for an estimate based on your own systems and a reference customer.
Can claims software connect to Salesforce?
Yes, some can. ClaimsGateway names Salesforce among its integrations, alongside Zendesk, MYOB Acumatica and Steadfast Insight. Other claims platforms connect to Salesforce through their APIs or custom work. Ask each vendor whether the integration is already built and which data moves between the two systems.
What is an integrated claims management system?
An integrated claims management system is claims software connected to the other systems a claim relies on, such as policy administration, finance, CRM and helpdesk, so data moves between them without re-keying. The integration can use real-time APIs, scheduled file exchanges or embedded views, depending on what each connection needs.
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
- API-first claims platforms: how vendors describe their APIs and integrations.
- Salesforce-integrated claims software: claims platforms that connect to Salesforce.
- Replacing a legacy claims system: moving claims without a multi-year programme.
Sources
- Norton Rose Fulbright. "Gearing up for mission critical: APRA's new expectations for insurers." November 2023. https://www.nortonrosefulbright.com/de-de/wissen/publications/1c90b2b8/gearing-up-for-mission-critical-apras-new-expectations-for-insurers
- Wilbur. Home page, checked 22 October 2026. https://wilbur.io
- ClaimsGateway. Website, checked 22 October 2026. https://www.claimsgateway.com
