AI-powered fraud detection platform specifically for claims management that provides real-time risk assessment, automated flagging of suspicious claims, predictive analytics, network analysis to detect fraud rings, and integration with existing claims systems. Offers a hybrid scoring model combining expert rules, predictive models, and text mining.
AI-powered tools that identify suspicious patterns, anomalies, and potential fraudulent activities in claims data. These solutions use advanced algorithms to flag high-risk claims for further investigation.
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Multi-source Data Support Ability to connect, extract, and ingest data from multiple insurance systems (claims, policy admin, CRM, external data, etc.). |
FRISS claims real-time integration with multiple insurance systems (claims, policy admin) and external sources; see FRISS documentation and website. | |
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Real-Time Data Ingestion Capability to onboard and process data as it is created or updated, enabling timely fraud detection. |
Described as providing real-time risk assessment for claims. | |
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Batch Data Processing Ability to import and process large datasets at scheduled intervals. |
Claims batch import functionality referenced in technical documentation and cloud/on-premises support. | |
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Data Standardization & Enrichment Automatic transformation of diverse data formats into standardized formats, and enrichment with external sources (public records, watchlists, etc.). |
FRISS claims automated standardization and enrichment as part of its data pipeline, as noted on product sheets. | |
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Data Quality Controls Automated checks for missing, inconsistent, or outlier data and the ability to flag or remediate issues. |
Product advertises data validation, missing data checks, and remediation as part of fraud flagging workflows. | |
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Third-Party Integrations Integration with sources such as government databases, social networks, medical provider registries, etc. |
Specifically promotes integration with external data providers, government lists, and watchlists. | |
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Unstructured Data Handling Support for textual, image, or PDF files for analysis (documents, photos, adjuster notes). |
Supports text mining on notes and documents, and handling of attachments (images, PDFs) for analysis. | |
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API Access APIs available for inbound and outbound data exchange. |
FRISS API documentation is public, and APIs are referred to for inbound/outbound integration. | |
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Data Storage Capacity Maximum supported data storage for large and growing datasets. |
No information available | |
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Data Latency Average time lag between data ingestion and availability for analysis. |
No information available |
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Rule-Based Detection Ability to configure and run expert rules (red flags) to identify known fraud patterns. |
Hybrid rules engine described for red-flag (expert/system) rules. | |
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Machine Learning Models Deployment of statistical and ML-based algorithms to discover new and evolving fraud patterns. |
Advertises combination of ML and statistical models (hybrid scoring model and AI-based detection). | |
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Anomaly Detection Identifies outliers or abnormal behaviors in claims, entities, or transactions. |
System performs outlier and anomaly detection, as per solution overview. | |
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Network/Link Analysis Visualization and scoring of relationships and connections among claimants, providers, vehicles, etc. |
Network/link analysis for detecting fraud rings particularly highlighted as key strength. | |
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Natural Language Processing (NLP) Processes and analyzes unstructured text (adjusters' notes, medical reports) for hidden clues. |
Mentions text mining and NLP used on adjuster notes and unstructured text data. | |
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Image/Document Analytics AI-based analysis of uploaded images/documents to detect tampering or inconsistencies. |
AI-based processing of document and image uploads for manipulation/tampering is indicated. | |
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Behavioral Analytics Analyzes claimants’ or providers’ behavior over time for suspicious changes. |
Behavioral analysis of claims and entities listed in advanced analytics. | |
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Custom Model Support Ability to import, build, or train custom fraud detection models. |
Supports building and deploying custom detection models—confirmed in product documentation. | |
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Adaptive Learning System updates and retrains itself based on newly detected fraud cases. |
Mentions continuous learning and periodic retraining of AI models. | |
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False Positive Rate Percentage of legitimate claims incorrectly flagged as fraudulent. |
No information available | |
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Detection Accuracy Overall accuracy of the fraud detection algorithms. |
No information available |
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Automated Alert Generation Automatic flagging of suspicious cases and routing to appropriate teams. |
Automated alerting is a core claim in FRISS product brochures and demos. | |
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Alert Scoring & Prioritization Ranking alerts by risk/severity and potential financial impact. |
Risk scoring and prioritization referenced throughout FRISS materials. | |
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Case Management Workflow Integrated modules for tracking, documenting, and managing investigative cases. |
FRISS includes a case management module according to feature lists and screenshots. | |
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Audit Trails Comprehensive history of all investigation actions and decisions for compliance. |
Audit trail for investigations, including decision tracking, is indicated as a compliance strength. | |
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Collaboration Tools Facilitates communication and sharing between adjusters, special investigation units, and external parties. |
Collaborative investigation & communication features mentioned for adjusters and SIUs. | |
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Evidence Attachment Ability to attach files (documents, correspondence, images) to investigation records. |
Evidence (document, photo, correspondence) upload supported in the SIU/case workflow. | |
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Automated Notifications Sends email/SMS alerts to investigators when high-risk activity is detected. |
Platform sends automated notifications (email, in-app) for alerts/escalations. | |
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Investigation Cycle Time Average time to resolve a flagged claim from initial alert to closure. |
No information available | |
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Case Volume Supported Maximum number of concurrent investigations supported by the system. |
No information available | |
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Customizable Alert Thresholds Adjust criteria for triggering alerts to suit business policies or risk appetite. |
User-customizable thresholds and criteria referenced in solution overviews. |
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Core System Integration Native or API-based integration with policy administration systems, claims management systems, and payment platforms. |
FRISS advertises API-based integration with major core admin, claims systems, and payment processors. | |
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Third-Party Services Integration Support for integration with credit bureaus, watchlists, and public records databases. |
Product integrates with credit bureaus, public records and watchlists, as per feature lists. | |
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Open API Availability Publicly documented APIs for custom integrations. |
API documentation is public and referenced in developer info. | |
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Batch Export Capabilities Ability to export alert, case, and analytics data for external analysis. |
FRISS supports batch exports for alerts, cases, and reports via admin UI/API. | |
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Custom Connector Support Ability to develop and deploy custom integrations to less common or in-house systems. |
Product claims capability for custom integrations for unique/legacy environments. | |
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Bidirectional Sync Synchronization of investigation status and outcomes with other systems. |
Bidirectional integration with core insurance systems is actively advertised. | |
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Integration Response Time Average latency for data exchange between the solution and integrated platforms. |
No information available | |
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Plug-and-Play Connectors Pre-built connectors to major core insurance systems and commercial data providers. |
Mentions pre-built connectors for major vendors (Guidewire, Duck Creek, etc.). | |
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Data Mapping Tools Visual tools for field mapping between systems. |
Visual field mapping in integration configuration described in admin guides. | |
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Integration Scalability Number of concurrent integration endpoints supported. |
No information available |
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Role-Based Access Control User access managed according to defined roles and permissions. |
Role-based access and permissions administration listed in compliance section. | |
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Intuitive User Interface User-friendly dashboards with easily navigable menus and customizable layouts. |
Product UI is marketed as intuitive, with drag-and-drop and configurable widgets. | |
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Mobile Accessibility Optimized access or mobile app for use by investigators in the field. |
Mobile app/support for field investigation noted in solution benefits. | |
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Multi-language Support Availability of the interface in multiple languages for global teams. |
No information available | |
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Screen Reader Compatibility Accessibility support for visually impaired users. |
No information available | |
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Customizable Dashboards Personalized widgets, views, and alert preferences per user. |
Supports personalized dashboards per user; referenced in UI/UX documentation. | |
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Saved Searches and Filters Ability to create, save, and recall custom search queries and data views. |
Ability to create and persist custom filters/searches is noted in product demo materials. | |
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Bulk Processing Capabilities Actions on multiple records at once (e.g., closing several cases, bulk notifications). |
Bulk actions (close, assign, notify) are available in case management module. | |
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Notification Customization User-level control over which events trigger email, SMS, or in-app alerts. |
Users may customize notifications via UI preferences. | |
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Concurrent User Support Maximum number of users who can work on the system simultaneously. |
No information available |
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Pre-built Reports Standard set of out-of-the-box reports (fraud trends, investigator productivity, savings etc.). |
Out-of-the box fraud and productivity reports included, shown in demos. | |
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Ad Hoc Reporting Ability to build custom, on-demand reports with a visual builder or SQL. |
Platform features ad hoc (custom) report builder, mentioned in reporting documentation. | |
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Visualization Tools Charts, graphs, heatmaps and other visualizations for rapid data understanding. |
Charts, heatmaps, and data visualizations are highly promoted for rapid insights. | |
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Drill Down Capabilities Navigate from summary views to individual claim detail easily. |
Report and dashboard drill down shown in FRISS demo videos. | |
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Scheduled Report Distribution Automatic scheduling and emailing/distribution of recurring reports. |
Scheduled and automated periodic report distribution capabilities mentioned. | |
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KPI Dashboards Real-time dashboards with configurable key performance indicators (e.g., detection rates, financial impact saved). |
Configurable KPI dashboards are visible on homepage and in marketing collateral. | |
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Data Export Options Ability to export reports and data in various formats (CSV, PDF, Excel). |
Data export functionality (CSV/PDF/Excel) available per reporting user guide. | |
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Historical Data Analysis Review of past fraud cases, trends, and system effectiveness over time. |
System supports reporting and analysis of historic trends and cases. | |
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Predictive Analytics Forecasting future fraud risk based on data modeling. |
Predictive analytics is promoted as a key differentiator for forecasting fraud. | |
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Report Generation Speed Time required to generate a typical report. |
No information available |
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Data Encryption at Rest All stored data is encrypted on disk. |
Describes encryption at rest as part of data privacy and compliance features. | |
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Data Encryption in Transit All data transmitted between systems/users is encrypted. |
Mentions end-to-end encryption for data in transit. | |
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Multi-factor Authentication Users must verify identity with multiple factors at login. |
Multi-factor authentication described as an available security control. | |
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Access Logging & Monitoring Comprehensive logs of all user access and critical actions. |
Audit logging and access monitoring covered in admin/security features. | |
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Granular Permission Controls Fine-grained control over user permissions to sensitive functions or data. |
Granular permission settings available in user management screens. | |
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Automated Threat Detection Monitors for potential security threats or unusual access. |
Threat monitoring described as part of operational security platform. | |
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Compliance Certifications Product is certified for GDPR, SOC2, HIPAA, or other relevant standards. |
References to GDPR, SOC2, and industry compliance certifications. | |
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Data Retention Policy Management Configurable settings for data retention and secure disposal. |
Data retention and disposal policies are configurable per compliance modules. | |
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Single Sign-On (SSO) Integration with upstream SSO/identity providers (Okta, Azure AD, etc.). |
Integration with external SSO (Okta, Azure AD, etc.) mentioned in enterprise integration list. | |
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Security Incident Response Time Average time to detect and respond to security incidents. |
No information available |
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Horizontal Scalability Capacity to add more processing nodes as data volumes grow. |
Scalable architecture claimed to support growing data volumes with additional processing nodes. | |
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Processing Throughput Maximum number of claims processed per hour. |
No information available | |
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System Uptime SLA Guaranteed minimum system uptime by the vendor. |
No information available | |
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Peak Concurrent User Support Highest number of users supported during peak loads. |
No information available | |
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Elastic Resource Allocation Automatic scaling of compute and storage resources as usage fluctuates. |
Automatic scaling is indicated in materials and is typical of SaaS/hybrid offerings. | |
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Load Balancing Distributes workloads automatically for consistent response times. |
Automatic load balancing discussed in solution architecture overviews. | |
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Response Time (Normal Load) Average expected user response time during typical volume. |
No information available | |
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Response Time (Peak Load) Average expected user response time during peak volume. |
No information available | |
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Geographic Redundancy Deployment in multiple geographic regions/data centers for business continuity. |
No information available | |
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Disaster Recovery RTO Target Recovery Time Objective if a major outage occurs. |
No information available |
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Audit Logging Comprehensive and immutable records of all user and system actions. |
Comprehensive audit/logging of actions is a compliance requirement and stated capability. | |
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Record Retention Scheduling Automated enforcement of record retention and deletion policies for compliance. |
Automated retention and deletion policies adjustable for legal/compliance demands. | |
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Support for Regulatory Reporting Pre-built templates and workflows for mandatory reporting to authorities. |
Regulatory reporting templates and workflows highlighted for insurance sector. | |
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Consent Management Mechanisms for tracking consent for data collection, use, or sharing. |
Consent management and audit trails support GDPR and other regulatory frameworks. | |
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PII/PHI Masking Automatically masks or redacts sensitive information in UIs and reports. |
Sensitive data masking/redaction a part of FRISS privacy-by-design principles. | |
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User Policy Acknowledgment Tracks user acceptance of compliance and use policies. |
Tracks user policy consent; necessary for regulatory compliance. | |
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Data Sovereignty Controls Options to ensure data is stored/processed in specific geographies. |
Data residency and sovereignty options discussed on website and compliance guides. | |
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Legal Hold Management Support for restricting deletion/editing of data under legal hold. |
Legal hold features available for litigation and regulatory retention. | |
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Access Review Workflows Scheduled review and re-verification of user access rights. |
Periodic access review and verification is part of compliance dashboard. | |
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Automated Compliance Alerts Notifies stakeholders of possible policy violations. |
Compliance policy violations are flagged and notified automatically. |
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Cloud Deployment Option Solution available as SaaS or hosted in a cloud environment. |
Available as SaaS and in public/private cloud as per deployment documentation. | |
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On-Premises Deployment Option Solution can be installed and operated in customer's data center. |
On-premise deployment is an available option for certain regulated customers. | |
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Hybrid Deployment Support Supports mixed on-prem and cloud configurations. |
Hybrid cloud/on-prem support is listed as an advanced deployment scenario. | |
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Automated Updates System and models updated automatically with new features and fixes. |
System/software updates delivered automatically for SaaS/cloud users. | |
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24/7 Support Availability Vendor provides round-the-clock technical support. |
FRISS advertises 24/7 support offerings globally. | |
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Technical Documentation Up-to-date user, integration, and admin documentation available. |
Online technical/user documentation (integration, admin, end-user) is current and available. | |
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Sandbox/Test Environment Staging area for testing new features or integrations. |
Test/sandbox environments are available for clients and partners. | |
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Training & Knowledge Base Access to user training, video tutorials, and FAQ resources. |
FRISS provides user training, FAQ, and knowledge base as onboarding material. | |
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Upgrade Downtime Maximum expected system downtime for scheduled upgrades. |
No information available | |
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Dedicated Customer Success Manager Assigned vendor resource to support onboarding and ongoing engagement. |
Dedicated customer success/support managers referenced for enterprise clients. |
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Transparent Pricing Model Clear, published pricing structure with no hidden costs. |
FRISS' pricing model is described as transparent, with up-front details available. | |
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Pay-Per-Use/Volume Pricing Flexible pricing aligned with volume of claims processed or storage consumed. |
Volume-based and tiered pricing available for large insurers. | |
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Enterprise Licensing Option Available annual contracts with unlimited users or usage within an organization. |
Enterprise license options for large clients are mentioned in commercial materials. | |
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Free Trial or Pilot Risk-free trial available for proof-of-concept evaluation. |
Free trial or pilot phase available for POC as referenced in sales/onboarding content. | |
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Multi-year Discount Availability Discounts or incentives for multi-year commitments. |
Multi-year contracts and associated discounts available on direct request. | |
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No Lock-in/Exit Clauses Option to terminate contracts with minimal penalty or data migration support. |
Minimal exit fees and standard data migration support for termination. | |
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Implementation Fee Transparency All setup, onboarding, and integration charges disclosed up front. |
Implementation and onboarding fees disclosed as part of proposal/SOW process. | |
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Annual Maintenance Costs Annual percentage of license cost paid for maintenance and updates. |
No information available | |
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Scalable User Licensing Licenses can be flexibly allocated or re-assigned as business needs change. |
Flexible allocation and reassignment of licenses as insurance clients' needs change. | |
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Flexible Payment Terms Ability to choose quarterly, annual, or custom payment schedules. |
Flexible/custom payment terms (quarterly, annual) available per sales portal and FAQ. |
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