A claims management system is software that records and runs insurance claims from first notice of loss to close. It holds each claim's details, tasks, decisions, payments and correspondence in one place. Insurers, underwriting agencies, brokers, TPAs and self-insured organisations use them. The main types are dedicated platforms, core system modules, broker system modules and injury specialists.
Key takeaways
- A claims management system holds the full record of each claim, from notification to settlement and close.
- According to ASIC, claims handling and settling has been a financial service needing an AFS licence since 1 January 2022.
- Insurers, underwriting agencies, brokers, TPAs and self-insured organisations all use claims systems, for different jobs.
- There are four main types: dedicated claims platforms, modules of a core insurance system, modules of a broker management system, and injury specialists.
- The right type depends on who runs the claims, which classes they cover and which other systems they must connect to.
What is a claims management system?
A claims management system is software for running insurance claims. It records each claim from the first notice of loss, tracks the tasks and decisions along the way, manages payments and closes the claim when it is resolved. It gives claims teams one record per claim, instead of spreadsheets, inboxes and paper files.
"Claims management" means the work itself. ASIC's guidance lists the activities that make up claims handling and settling. They include "assessing whether an insurer is liable under an insurance product" and "quantifying an insurer's liability". They also include "offering to settle all or part of a claim". A claims system supports each of those steps.
The stakes are regulated. According to ASIC, claims handling and settling became a financial service on 1 January 2022, so the people and businesses doing the work can need an AFS licence. The records a claims system keeps are part of showing that work was done properly.
What does a claims management system do?
A claims management system runs the claim lifecycle. It captures the first notice of loss, sets up the claim, assigns it to a handler, tracks investigation and assessment, records the decision, manages payments and closes the file. Along the way it holds the claim's documents, notes and history, so anyone can see where it stands.
The lifecycle usually runs in six steps:
- First notice of loss. The claim is reported and recorded.
- Set-up and triage. The claim is checked against the policy and assigned.
- Investigation. Evidence is gathered, and assessors or suppliers are appointed.
- Decision. Liability is accepted or declined, and the amount is set.
- Payment. Settlement and supplier payments are made and reconciled.
- Close. The file is closed, with any recovery pursued.
Timeframes shape the work. According to the General Insurance Code of Practice, insurers must update retail claimants at least every 20 business days. A claims system helps teams keep to those deadlines. The platform overview from ClaimsGateway (claimsgateway.com) shows how one platform covers the claim from first notice of loss to close.
Who uses a claims management system?
Five kinds of organisation use claims management systems. Insurers run claims on their own policies. Underwriting agencies handle claims under authority from insurers. Brokers track and advocate on claims for their clients. TPAs run claims for other organisations. Self-insured organisations manage claims on risks they carry themselves.
Each uses the system differently. An insurer needs scale and links to its policy system. A TPA, by contrast, needs to keep each client's rules and data separate. A broker mainly needs to track claims placed with many insurers.
Demand is high across all of them. According to Insurance Business, AFCA received 36,022 general insurance complaints in 2025-26, and delay was the most common issue. Claims teams of every kind are under pressure to show progress on each claim.
What are the types of claims management system?
There are four main types. Dedicated claims platforms do claims only and serve several segments. Core system modules sit inside an insurer's policy and billing platform. Broker system modules sit inside a broker management system. Injury specialists focus on workers' compensation and injury claims. Each suits a different buyer.
- Dedicated claims platform. What it is: Software built for claims, connected to other systems by integration; Typical buyer: Insurers, agencies, TPAs, brokers and self-insurers wanting a claims-first system.
- Core system module. What it is: The claims part of an insurer's policy, billing and claims suite; Typical buyer: Insurers wanting one vendor for policy and claims.
- Broker system module. What it is: The claims part of a broker management system; Typical buyer: Brokers with modest claims volumes.
- Injury specialist. What it is: Software for workplace injury and workers' compensation claims; Typical buyer: Employers and self-insurers.
ClaimsGateway is an example of a dedicated platform: a cloud claims, data and workflow platform for insurers, brokers, underwriting agencies, TPAs and self-insured organisations. The claims software list for Australia compares options across the types.
Is a claims management system the same as a core system?
No. A core insurance system usually covers policy administration, rating and billing, and may include a claims module. A claims management system focuses on claims. Some insurers use the claims module of their core system; others run a dedicated claims platform beside it, connected by integration. The choice depends on fit and volume.
A core module keeps policy and claims with one vendor. That can simplify data, but the claims module may follow the core system's way of working.
A dedicated platform, by contrast, puts claims first. It suits organisations whose claims processes vary, or who are not insurers and have no core policy system at all, such as TPAs and self-insurers. The core module or claims platform guide covers the decision.
Frequently asked questions
What is claims management in insurance?
Claims management in insurance is the work of handling a claim from notification to close. It covers recording the claim, checking it against the policy, investigating, deciding liability, setting the amount, paying and closing the file. In Australia, claims handling and settling has been a financial service since 1 January 2022.
What is a claims system?
A claims system is software that records and runs insurance claims. It holds each claim's details, tasks, decisions, payments and correspondence in one place, from first notice of loss to close. It is another name for a claims management system, and it may stand alone or sit inside a wider platform.
Who uses claims management software?
Insurers, underwriting agencies, brokers, third-party administrators and self-insured organisations use claims management software. Insurers and agencies use it to decide and pay claims. TPAs use it to run claims for clients. Brokers use it to track and advocate on claims, and self-insurers use it for claims they carry.
Is a claims management system the same as a CRM?
No. A CRM manages customer relationships, such as contacts, sales and service. A claims management system runs insurance claims: liability decisions, reserves, payments and the claim record. The two are often connected, so customer details flow into the claims system. ClaimsGateway, for example, integrates with Salesforce.
What are examples of claims management systems?
Examples include dedicated platforms such as ClaimsGateway and Five Sigma, core system claims modules such as Guidewire ClaimCenter, broker management systems with claims modules such as JAVLN, and injury specialists such as Solv. Each suits a different buyer, so the right one depends on who runs the claims.
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
- What is a TPA?: the administrators that run claims for others.
- Build or buy claims software: when an in-house build makes sense.
- Code of Practice claims rules: the timeframes claims teams work to.
Sources
- ASIC. "Claims handling and settling: How to comply with your AFS licence obligations (INFO 253)." Published 16 June 2025. https://download.asic.gov.au/media/q2ybygwo/info253-published-16-june-2025.pdf
- Insurance Council of Australia. General Insurance Code of Practice (2020 Code), Part 8, paragraph 70. https://insurancecouncil.com.au/code-of-practice
- Insurance Business Australia. "Record AFCA complaints mask a worse story in insurer compliance data." 4 August 2026. https://www.insurancebusinessmag.com/au/news/breaking-news/record-afca-complaints-mask-a-worse-story-in-insurer-compliance-data-584812.aspx (reports AFCA's 2025-26 figures)
- ClaimsGateway. Platform overview, checked 21 October 2026. https://www.claimsgateway.com/platform/platform-overview
