Celent Claims System Vendors

Celent Claims System
Vendors: North American

Property Casualty Insurance
By Karlyn Carnahan, Donald Light,
and Andrew Schwartz
April 22, 2022

Claims System Vendors: North American
Property Casualty Insurance
By Karlyn Carnahan, Donald Light, and Andrew Schwartz.
This is an authorized excerpt
from a Celent report profiling
Property Casualty Claims
Appian is pleased to share our profile from Celent’s 2022 edition of the Administration vendors. The
Claims Systems Vendors: North American Property Casualty Insurance reprint was prepared for
report. We’re excited to be recognized as a Technology Standout, excelling Appian but the analysis has
with advanced technology in a focused set of functionalities while not been changed. For more
continuing to broaden our offering. information about the full
report, please contact Celent
Appian Connected Claims helps insurers streamline and automate their
at [email protected].
claims process to optimize claims handling, increase straight-through
processing, reduce claims leakage, and improve the customer experience.
Built on the Appian Low-Code Platform and deployed on the Appian

Cloud, each modular application in Connected Claims is designed to
target operational gaps and optimize claims handling using intelligent
automation to deliver an immediate business impact and accelerate time
to value.
Find out more in the report.
Learn more at
appian.com
Contact us at
[email protected]
CLAIMS SYSTEMS
VENDORS: NORTH
AMERICAN PROPERTY
CASUALTY INSURANCE,
2022 EDITION
POWERED BY VENDORMATCH
This is an authorized reprint of a Celent report granted to Appian. The report was written by Celent and was not
sponsored by Appian. For more information, please contact Celent ([email protected])
Karlyn Carnahan, Donald Light, and Andrew Schwartz

27 April 2022 (revised)
CONTENTS
Executive Summary .......................................................................................................... 3
Introduction ..................................................................................................................... 4
Core Claims Systems: Definition and Functionality ............................................................ 5
Report Methodology ...................................................................................................... 13
Celent’s ABC Vendor View and Technical Capability Matrix ............................................. 17
Appian: Appian Connected Claims .................................................................................. 20
Concluding Thoughts ...................................................................................................... 40
Leveraging Celent’s Expertise.......................................................................................... 42
Related Celent Research ................................................................................................. 43
Copyright Notice ............................................................................................................ 44
© CELENT
Claims Systems Vendors: North American Property Casualty Insurance, 2022 Edition Executive Summary
EXECUTIVE SUMMARY
This report provides an overview of the claims administration systems available

in North America for property-casualty insurance carriers. The report profiles 23
core claims solutions and provides an overview of their functionality, customer
bases, lines of business supported, technology, implementation, pricing, and
support.
© CELENT 3
Claims Systems Vendors: North American Property Casualty Insurance, 2022 Edition Introduction
INTRODUCTION
The claims process is the cornerstone of the insurance value proposition. After
all, the promise to indemnify a policyholder in a time of need is the reason why
the insurance industry exists. The claim, which is the path to indemnification, is
not only the costliest part of the insurance process, but it is also one of the
only times the policyholder directly connects with the carrier. As such, the
claims process can be a powerful determinant of customer experience. The
processing and handling of a claim, and the claim payment itself, are the
largest components of operational cost and, in turn, a major determinant of
underwriting profitability.
A confluence of forces has led to an increased focus on the claims process. Rising
external customer expectations for claims speed and accuracy, along with a
heightened internal focus on boosting operational efficiency, are two of the
driving factors. Carriers’ interest in claims is evidenced by Celent’s 2022
Property/Casualty CIO Priorities and Pressures survey, where 59% of respondents
noted they were currently replacing, beginning replacement, or making
significant enhancements to their core claim system.
This report profiles many of the property casualty claims administration systems
available in North America today. This report should help insurers define their
core systems requirements and, where appropriate, create a shortlist of vendors
for evaluation. Expanded claims functionality and improved technology mean
that insurers continue to have a wide set of systems and vendors to consider
when looking for a solution to fit their needs. Insurers are encouraged to contact
the authors of this report through analyst access to learn more about the
vendors and solutions.
© CELENT 4
Claims Systems Vendors: North American Property Casualty Insurance, 2022 Edition Core Claims Systems: Definition and Functionality
CORE CLAIMS SYSTEMS: DEFINITION AND

FUNCTIONALITY
Definition
A core claims system is a transaction-enabled system of record that an adjuster or claims
handler (or an automated process) uses to:
• Gather and process information regarding the underlying policy and coverages,
the claim, and the claimant.
• Evaluate and analyze the circumstances of the claim.
• Make decisions and take actions, including payment.
• Execute transactions and preserve a record.
A core claims system does these things over the entire lifecycle of a claim, from first
notice of loss through final settlement and closing the active claim file. A claims system
typically integrates with policy administration systems to support coverage verification
and to provide information back to the underwriter for ongoing decision-making. It
integrates to a general ledger and to a disbursement solution or function. Claims systems
do not include document creation, document management, reinsurance, and reporting,
but typically integrate to those systems. Additionally, claims systems may integrate to a
CRM solution, a wide variety of third party data services, and additional third party
applications to support capabilities such as estimating, bill review, and analytics. Most
solutions also support EDI requirements for FROI/SROI, CMS reporting, or other
requirements based on jurisdiction. There is increasing interest in providing claim
information back to the policy administration system for use in underwriting renewals.
© CELENT 5
For the purpose of analyzing solutions, Celent makes the distinction between basic,
advanced, and technical functionality, as explained below.
Basic Functionality
All modern core claims systems provide basic functionality for an adjuster’s standard
tasks.
Figure 1: Core Claims Systems Layers of Functionality
Source: Celent
© CELENT 6
First Notice of Loss / First Report of Injury (FNOL/FROI): This is the start of the claims
process. The solution typically has a data input mechanism to gather information about
the claim. Many solutions provide dynamic questions, allowing for a more streamlined
approach to the user interface by presenting only necessary questions. Some solutions
provide a sidebar or overlay that includes a script for a claims intake representative to
help guide a consistent claims experience. Many solutions can extend the FNOL intake
mechanism to a portal with a simplified interface for a claimant. Some also provide
mobile intake mechanisms. Integration with a policy administration system allows some
coverage verification to occur during the FNOL/FROI. Some solutions use this integration
to prefill information for the FNOL/FROI. Some claims solutions allow a carrier to open a
claim without a policy in force, while others require the policy to be in force.
Scoring and Alerts: Many solutions are able to handle some type of scoring in the
background. Some do this by explicitly identifying claims characteristics and assigning
points. When the total points exceed a certain threshold, an alert is created. Alerts are
typically used when some kind of special handling is needed, either because of potential
fraud or due to the complexity of the claim. This scoring mechanism is often a key aspect
of a carrier’s operationalization of a predictive model. Solutions that do not have explicit
scoring mechanisms can often reach a similar capability by using business rules.
Claims Assignment: While many carriers still assign claims manually, more and more
carriers are looking for automated support in the assignment process. Solutions handle
claims assignment in a variety of ways. Look for the ability to either assign claims using a
round-robin capability or to assign them to specific individuals. Some solutions can assign
a claim very granularly based on line of business, claim complexity, geography, and
workload. Most systems allow multiple adjusters to be assigned to work on a single claim
handling different suffixes or sub claims. Carriers also look for capabilities for manual
assignment or reassignment for both bulk transactions and single claims or suffixes/sub
claims.
Reserves: All claims solutions provide the capability for setting and changing reserves.
Areas of variation include the level of granularity and hierarchy of reserve setting.
Typically, those that provide limited levels of reserves do provide more granularity for the
actual payments, allowing carriers to analyze spending. Some systems allow automatic
reserve setting. Most solutions that support automatic reserves do so using a table. A
carrier can pre-identify certain claim types and populate a table with the reserve type
and amount. Some solutions can calculate a reserve dynamically using business rules
based on specific claim characteristics. Look for the ability to not only change the total
reserve amount, but also to add a specific reserve change amount (e.g., either add $5,000
to the current reserve or change the total reserve to $25,000). Some solutions do a nice
job of aggregate tracking to monitor the erosion of policy limits. Many, but not all, also
include deductible tracking for both small deductibles and self-insured retentions. For
workers’ compensation, look for tools that tie reserves to jurisdictional rate and wage
calculations. Some solutions include reserve worksheets that assist adjusters in
calculating the appropriate reserve.
Payments: All claims solutions are able to create payments. However, there is wide
variation in the functionality across solutions. Typically, the payment functionality
includes an authority verification, confirmation against reserve limits, and integration to a
third party payments module to print checks. Some are tightly linked to the reserve
process and allow reserves to be changed at the same time the payment is being made.
Others require that the adjuster exit the payment process, increase the reserve, and then
return to issue the payment. Many, but not all, solutions support split payments,
multiparty payments, and recurring payments. Those with recurring payments may allow
temporary payment suspension, make it easy to change payment dates, and
automatically run holiday calculations. Some solutions allow bulk payments if that
© CELENT 7
preference is specified at the vendor level. Others handle bulk payments by requiring that
each payment be manually marked as bulk. Some solutions allow payments, such as
expenses, to be made against closed claims, while others do not support this
functionality.
Recoveries: Subrogation and salvage are functions performed by all carriers. However,
there is wide variation in how software solutions handle these functions. Some solutions
have specific modules with separate screens, workflows, calendaring, and even analytical
tools to help score and evaluate demand strategies and percent at fault. Other solutions
assume the carrier will set up subrogation as a separate set of workflows within the
existing functionality. Some solutions permit reserving for recoveries, while others allow
the carrier to set up an expected recovery without actually hitting the reserves. Some
solutions provide none of the above.
Vendor Management: All solutions allow carriers to track contact information for
vendors, and most also include tracking for banking information and 1099 data. Some
solutions also include scoring mechanisms to rate and rank vendors. Some include
integration to vendor scheduling tools to allow a claims intake coordinator to identify
nearby vendors and schedule services at the time of FNOL. Some solutions include
readymade portals through which vendors can manage their own information, and some
allow vendors to manage their own payments.
Adjuster Desktop: A wide variety of tools are available to help the adjuster manage their
workload. Adjuster desktops typically include an area where open claims and assigned
tasks are easily found. User interfaces can vary widely but often include features such as
the ability to sort by clicking on columns, to filter columns, and to drag and drop and
rearrange columns. All solutions include search, but some include sounds-like search,
partial word search, Boolean search, or wildcards. Most systems allow adjusters to create
manual diaries, tasks, and notes. Many are integrated with email, allowing an adjuster to
send an email from the desktop. Many include a claim summary that contains the most
important information about a claim and is available at a glance from any location within
the claim. Some solutions allow the adjuster to customize their own workspace by
choosing which modules they want displayed, selecting a color scheme, or adding links to
commonly used third party websites. Other capabilities like configurable help text, hover-
overs, and wizards can help an adjuster easily navigate through various tasks.
Document Creation and Management: Most of the solutions include some sort of
correspondence or forms library for the most common letters and forms. Some also
contain document management capability for storing internally generated documents or
external documents such as photos, videos, and other media. Some integrate with third
party solutions to provide additional capabilities. Many systems can automatically
generate correspondence or forms using business rules and task generation capabilities.
When an event occurs, or the data within a field changes, the solution can automatically
create correspondence that can often be delivered using a variety of mechanisms
including mail, email, and SMS. Look for the level of granularity in indexing forms being
created. When a claim file holds hundreds of items, being able to rapidly sort to find the
document needed can save time. Look for the ability to search not only through the
metadata about the document, but within the document itself.
Supervisory Management Tools: Claims supervisors look for a variety of capabilities to

effectively manage the claims department. Some solutions allow for easy reassignment of
work, including individual tasks, individual claims, and bulk changes. Look for the data-
driven capabilities that allow a supervisor to preschedule these changes, as some
solutions permit only immediate changes. Some solutions allow for temporary
reassignments with start and finish dates for events like vacations. Look for the ability to
easily add new employees and to set and manage authority. Also look for automated
© CELENT 8
escalation procedures to route claims easily when additional authority is needed.

Workload balancing tools are built into the claims assignment routines for some
solutions. For others, reports allow supervisors to get a picture of employees’ workloads
and key performance indicators. Most solutions include data and time stamps for logging
audit trails.
Reporting: Reporting capabilities vary widely across solutions. Virtually all solutions
integrate with a third party reporting tool. Some include a third party reporting tool out
of the box with the solution. Some solutions use open source reporting tools, and some
have in-house solutions. Most include some level of prebuilt standard reports that can be
subscribed to or scheduled. Standard reports typically deliver operational reports,
performance measures, and some level of financial reporting. Look for the number of
reports included out of the box. Ad hoc capabilities vary widely. Some are quite easy to
use, with the ability to drag and drop data elements and build a report very simply. Many
include dashboards with graphical views of data, and many of those include drilldown
capabilities. Some vendors also provide tools for directing claim data to data stores
(typically at an additional cost).
Advanced Functionality
In addition to the basic functionality provided by virtually all solutions, carriers often
need advanced functionality depending on the complexity of their business, the lines of
business they write, or the geographies they write in.
Catastrophe Management: All carriers are vulnerable to a wide variety of catastrophes.

Varying levels of support are available. Some solutions support cat management by
running reports to identify claims that are likely to be part of a catastrophe. Some
support manual tagging of a claim as a cat claim. Some solutions automate the process by
allowing carriers to define catastrophes by peril(s), LOB(s), geography, date, or other
criteria. The solution can then automatically tag claims that meet those criteria as
potential cat claims. Some have geographic mapping of the claim available, typically
through integration with Google or Bing maps. Look for the ability to mark a cat with an
ISO claim number or to create a carrier-specific number and convert to an ISO claim
number if needed.
Reinsurance: Like catastrophe management, systems handle reinsurance in a variety of

ways. Most assume the carrier will run a report identifying claims subject to reinsurance
by specifying a limit or peril. Some allow an adjuster to mark a claim as subject to
reinsurance. Occasionally, a solution will provide more ability to define reinsurance
contracts and identify claims subject to reinsurance. Tasks related to managing
reinsurance, such as notifications and required communications at certain points in a
claim, can be handled using business rules and task generation.
Workers’ Compensation Rehabilitation Management: Functionality specific to workers’

compensation is not available in every solution. Those that handle workers’
compensation are more likely to have modules to manage the return to work and
rehabilitation programs. These solutions may include features such as the ability to
calculate recovery dates as well as integration with industry standard duration guidelines
and templates for return-to-work plans, including three-point contact.
Medical Case Management: Systems that handle workers’ compensation are more likely
to have robust medical case management tools with features such as diagnosis tracking,
medical records, and the ability to create treatment or action plans. Some allow external
parties such as nurse case managers to access the claim. Some feature capabilities such
as utilization management, service authorization tools, and bill review—or integration
© CELENT 9
with an insurer’s managed care networks (for medical, rehabilitation, drugs, and the like)
and bill review solutions. Solutions that do not specialize in workers’ compensation may
still capture injury and medical treatment details. Many support ICD9 and ICD10. CMS
reporting is also included in a number of solutions.
Litigation Management: Most solutions offer the ability to mark claims that are in
litigation. Some solutions also offer specific litigation management modules, which may
include a separate workspace with a separate set of roles and permissions. These
modules can be quite robust, with the ability to keep a record of the litigation process,
statutory dates, venues, demands and offers, and even calculation of potential outcomes.
Other key litigation features to look for include the ability to configure separate
workflows and separate permissions and roles, as well as the ability to easily index large
numbers of documents. Some solutions also include bill review tools that allow the
carrier to electronically receive, review, modify, and pay legal invoices.
Fraud: Few solutions have robust fraud analytic tools built in, although most can
integrate with third party solutions. Generally, claims systems handle fraud by using
scoring mechanisms, automated alerts, and workflow processing that can route claims to
a special investigation unit.
Mobile/Multichannel Access: Almost all solutions are browser-based and available via a
tablet or mobile device for an adjuster in the field. More and more have been optimized
for mobile devices using HTML5 or responsive design. Many solutions include some level
of role-based security that allows separate access and modified user interfaces to be
exposed via a portal to an agent or claimant. Some solutions come with mobile
applications out of the box that allow a potential claimant to provide their First Notice of
Loss through simplified interview questions or wizards and the ability to upload photos.
Technical Functionality
While the assessment of features and functionality is a critical step in selecting a claims
system, there are a number of technical considerations to be thought through as well.
Configuration Tools: A general trend in insurance software is to create tools that allow
carriers to modify the system through configuration tools rather than through code. The
most robust tools allow carriers to easily add data elements, create business rules,
modify workflows, create forms, create screens, and modify the user interface, all using
configuration tools. Some tools are extremely intuitive, with drag-and-drop and point-
and-click capabilities. Others require knowledge of a scripting language to make the
changes. Many vendors are moving toward a dual development environment with
simplified tools and wizards meant for Business Analysts to make general changes and a
more robust environment for technical staff to use.
Business Rules: Look for the ability to design and execute business rules and
underwriting rules that are separate from the core program code. Carriers should assess
the ability to reuse and share rules. Some tools are extremely intuitive and use natural
language; others require knowledge of scripting or programming languages. Some have
visualization tools that allow a carrier to use a Visio-like tool to build business rules. Some
solutions include a searchable and version-controlled rules repository. A few solutions
offer tools to help carriers conduct impact analysis of the rules, or traceability tools to
help them understand how and when rules are being used. Since many carriers create
hundreds or thousands of rules, there should be a strong rules management environment
with a well-organized repository, version control and version storage, etc.
© CELENT 10
Integration: Claims systems integrate with a large number of third party systems and
external data sources. Most solutions have been designed with a service-oriented
architecture and have a variety of ways of handling integration, with many settling on the
use of RESTful APIs as the common standard. Most systems have some kind of
accelerator or have experience integrating with the most common third party data
sources and the most common document systems. Claims systems, however, integrate
with a wide variety of other solution types—medical bill review, fraud analytics, EDI,
estimating systems, and payment systems, to name a few. With the rise of insurtech, new
data platforms and fast integration capability will be a deciding factor in insurers’ agility.
Workflow: Some solutions serve more as data capture tools. Workflow is sometimes
expressed by flows within a screen or among screens. Other solutions have true workflow
capabilities that allow them to automatically generate and assign tasks based on event
changes in a claim, time lapse, or data changes in a field. Some of the solutions profiled
have a graphic design environment with automated background code generation. This
means graphical depictions are actionable; clicking on a step allows the carrier to modify
that step, or steps can be dragged and dropped to rearrange the sequencing. It is not
uncommon for a software vendor to use a third party or open source tool to manage the
workflow requirements.
Data: Data is more and more important for carriers, and software vendors are
acknowledging this by building in more tools to help carriers with their data needs. Some
solutions deliver a certain number of extra fields that users can modify for their own use.
More common are configuration tools that allow the easy creation of data elements,
including the ability to mask data, encrypt data, add context-specific help text, and
modify the data model. Self-documenting data dictionaries are available. Some solutions
come with an ODS out of the box and may even include a data warehouse with the
appropriate ETL tools. Most solutions are built on an industry standard model, such as
ACORD.
Release Management: Some solutions include workflow capabilities to handle the

release management within the claims system. Some feature full ticket management.
Look for the ability to package a group of changes or filings together that you can manage
as a release, as well as the ability to assign and track the work packets. Multi-tenant
cloud deployment can enable seamless updates.
Security: Security is of critical importance. Ask about the security standards the vendor
complies with and which certification and assurance methods are used. Look at how the
system handles security for managing APIs for application-level integration. Any claim
system’s payment functionality should be PCI compliant. Look at which authentication
capabilities the system leverages for internal and external users. A broad range of
capabilities are available, from one-time passwords to security tokens/PINS, multifactor
authentication, federated identity support, and even biometric security support. With
regard to cybersecurity, look for whether the software has penetration security and how
the system has been tested.
Integration: Core claim systems often integrate to large numbers of third party systems
and external data sources. Most solutions have been designed with a service-oriented
architecture and have a variety of ways of handling integration, with many settling on the
use of APIs as the common standard. Most systems have some kind of accelerator or
experience integrating to the most common third party data sources. With the rise of
insurtechs, new data platforms, and the position of claims as a participant in a wider
ecosystem, fast integration capability will be a deciding factor in insurers’ agility. Look for
whether the solution provider has existing partnerships with claims point solutions that
enable seamless integration with the core claim system.
© CELENT 11
Implementation: Vendors use a wide variety of implementation methodologies. Some

prefer to handle all the implementation themselves. Others prefer to work with third
party system integrators. More and more vendors are moving to agile or a hybrid
methodology. Look to see what methodology the vendor uses and how it aligns with your
own preferred approach. Some vendors are very good at helping insurers transition to an
agile methodology. Look for the artifacts they have available for gathering requirements,
documenting product architecture, and capturing business rules. Vendors claiming very
fast implementation timeframes may indeed have better artifacts and more configurable
solutions, or they may be touting very simple single-product implementation with little or
no configuration. Be sure to do customer reference checks to understand how well the
vendor handles project management, knowledge transfer, and scope creep with insurers
of a similar size and complexity as your company.
Cloud: Cloud-enabled solutions are on the rise, with most of the responding vendors
reporting that they have cloud-enabled core systems. When it comes to the term “cloud,”
there are many different variations available. Many vendors offer a hosted version of
their software. The software is licensed by the carrier and is hosted by the vendor in its
own data center or in a private data center like Rackspace. Increasingly, software is being
hosted in a public data center like AWS or Microsoft Azure. Look for the level of managed
services available if you are interested in this option. Additionally, look to see if the
solution includes cloud native features such as dynamic scaling or AI/machine learning
modules. AWS, Microsoft, and other cloud vendors often include additional support to
help insurers ensure they are using cloud capabilities reliably and efficiently while finding
smart ways to manage the costs.
Suite Capabilities
Celent has limited the definition of a claims administration system to include a set of core
processes and key supporting capabilities. However, vendors do not necessarily limit their
definitions in the same way, and many have attempted to build out some or all of the
end-to-end components that an insurer might need. Some insurers are just looking for a
best-of-class claims system to work with other core systems already installed, but others
may be looking for a vendor that can offer broad solutions for multiple areas of their
insurance operations.
In order to help insurers compare the different solutions, each profile in this report has a
table summarizing whether the vendor offers one or more of the end-to-end
components.
© CELENT 12
Claims Systems Vendors: North American Property Casualty Insurance, 2022 Edition Report Methodology
REPORT METHODOLOGY
In this report, Celent’s objective is to include as many as possible of the leading

claims administration systems being used or actively sold to insurers in North
America. Celent actively reviews vendor systems in the insurance software
market and invites the vendors to participate in reports like these.
Criteria for Inclusion

Celent actively reviews vendor systems in the insurance software market. Some solutions
qualified for profiles that include customer references and a Celent opinion of the
solution. These solutions are also ranked in the ABC analysis.
Celent’s ABC analysis is used to highlight vendors that have attained success selling their
systems in the North American market. In general, in order to have a full profile and be
included in the ABC grid, a claims administration solution had to have:
• At least one new sale to one new customer in the region within the last 24 months.
• At least three live customers per region, at least one of which must be an insurer.
• Participation by at least three reference customers.
• A 90-minute solution demonstration.
There are 16 solutions that meet these criteria and are included in this report with ABC
profiles.
Celent also profiles a number of other solutions. Solutions that did not qualify to be
ranked in the ABC analysis do not include a customer reference or a Celent opinion.
It is important to note that the information available in this report is also available in
Celent’s online resource, VendorMatch. In addition to this report, Celent also suggests
reviewing VendorMatch information, which may be more current.
About the Profiles

Each profile is structured the same way. Profiles present information about the vendor
and its claims administration system offerings, its geographic presence, and its client
base. Charts are used to provide more detailed information about specific features such
as lines of business supported, technology, and partnerships.
The profiles are presented in alphabetical order.
© CELENT 13
Limitations
Celent believes that this study provides valuable insights into current offerings in claims
administration solutions. However, readers are encouraged to consider these results in
the following context: The vendors self-reported. Participants in the study were asked to
indicate which claims administration capabilities were provided in addition to providing
generic information about their client base. Celent did not confirm the details provided
by the participants.
Evaluation Process
To analyze the capabilities of claims administration solutions that are active in the
insurance marketplace, Celent sent an invitation to participate in this year’s report to a
broad set of claims vendors. There was no cost for vendors to participate.
Each participating vendor completed an online RFI in Celent’s VendorMatch/RFX

platform. The RFI requested information about the features provided in the solution, the
technology and architecture, the current client base, the pricing models, and the vendor
itself. RFIs were completed on 24 products for North America.
After Celent received completed RFIs from the vendors, each vendor was evaluated for
meeting the criteria for inclusion in the ABC analysis. Those vendors that qualified for
Celent’s ABC evaluation provided a briefing and demo for Celent focusing on usability and
functionality for everyday users, product and rules configurability for IT and system
administration users, and the overall architecture of the system.
Celent also asked references provided by each vendor in the ABC analysis to complete an
online survey to obtain their view of the system’s business and technology value.
The RFIs, the demos/briefings, and the reference surveys provided quantitative and
qualitative data that was used in the ABC analysis of these vendors. This process is
described in the next section.
Vendors had an opportunity to review their profiles for factual accuracy and to provide
their own perspectives but were not permitted to influence the evaluation.
Some of the vendors profiled in this report are Celent clients, and some are not. No
preference was given to Celent clients for either inclusion in the report or in the
subsequent evaluations.
Celent used its unique VendorMatch platform to gather RFI data from each vendor.
VendorMatch is the world’s largest vendor and solutions data store—combined with
analytical tools—to help financial institutions find, evaluate, and select a solution. Each
profile contains a link to the solution’s VendorMatch profile.
The RFI for this market research gathered information across multiple dimensions,
including:
• Company information
• Product overview
• Specific information about the vendor and the system—including, among others:
– Functionality
– Technology
– Implementation and support
– Commercial terms
– Customer base
© CELENT 14
As part of the VendorMatch RFI process, Celent gathered much more information about
each solution than is reflected in this report. Subscription clients can leverage analyst
access to connect with the author and learn more about the vendors. They can also use
Celent’s VendorMatch platform to review a vendor’s online company and product
profiles. Since the online database can be updated at any time, the online data may be
more current than this report.
Customer Reference Feedback

Celent used an online survey tool to gather feedback from client references provided by
each vendor. The survey asked about client views of the solution’s business and
technology value and assessed the vendor’s customer service. The survey also asked each
client what it liked best about the vendor they use and asked for suggestions for
improvement. Anonymous results of the client surveys are reflected in the profiles,
including a diagram that displays the average ratings given to the vendor in six categories.
It is advisable to keep in mind that the evaluations and comments may vary according to
the specific needs of each reference client.
Table 2: Customer Feedback Ratings
Questions Rating Included in the Average

Asked
Functionality – First Notice of Loss (FNOL) / First Report of Injury (FROI)
How would you – Adjuster’s desktop/workstation
rate the features
– Reserving
and functions you
are currently – Making and managing payments
using? – Workflow/task generation
– Notes, diaries, calendaring
– Document generation and management
– Medical case management / disability management
– Multi-Channel capabilities (e.g., portal, mobile)
– Supervisory Tools (e.g., ability to assign work, vacation rules)
– Managing Suppliers (e.g., vehicle repair, building contractors,
medical/rehab providers)
– Reporting, business intelligence
– Statistical reporting (e.g., ISO)
Technology – Ease of system maintenance
How would you – Flexibility of data model
rate the
– Configurability
technology of this
solution in the – Ease of integration with internal and external data/systems
following areas? – Vendor’s timing in improving technical performance through
new releases and fixes
Integrations – Internal core applications, such as policy admin or reinsurance
What has been – Other internal applications, such as reporting, documents, or
your experience financial systems
integrating this
– Internal data sources, such as a data warehouse
system with the
following – External applications and data sources
components?
© CELENT 15
Questions Rating Included in the Average

Asked
Upgrades – Ease of the overall upgrade
How would you – Speed of the upgrade
rate upgrades of
– Cost of the upgrade
this system?
Implementation – Responsiveness (handling of issue resolution)
How would you – Project management (estimations, scope creep, etc.)
rate the
– Implementation completed on time
implementation
experience with – Implementation completed on budget
this vendor in the – Knowledge of your business
following areas?
– Knowledge of their solution and relevant technology
– Continuity with the implementation team—did the core team
stay engaged through to implementation?
– Overall project success
Support – Timeliness of responses to service requests
How would you – Quality of response to service requests
rate this vendor’s
– Cost of services
ongoing post-
implementation – Knowledge of your business
support in the – Knowledge of their solution and relevant technology
following areas?
– Communication—proactive communication of issues and
changes
– Consistency in meeting SLAs
– Roadmap delivery
Source: Celent
© CELENT 16
Claims Systems Vendors: North American Property Casualty Insurance, 2022 Edition Celent’s ABC Vendor View and Technical Capability
Matrix
CELENT’S ABC VENDOR VIEW AND TECHNICAL

CAPABILITY MATRIX
To help financial institutions better understand the vendor landscape and compare
providers, Celent developed its ABC methodology, which positions vendors across three
dimensions:
Advanced Technology
Breadth of Functionality
Customer Base and Support
While this is a standard tool that Celent uses across vendor reports in many different
areas, each report will define the ABC categories slightly differently. The final rating is
determined by Celent’s and customers’ score of these factors, when appropriate, as well
as Celent’s view of the relative importance of the factors as they apply to both the
solution and vendor’s capabilities.
Table 1: Examples of Factors Used in Celent Claims Administration System ABC

Evaluation
ABC Categories Possible Factors
Advanced Technology – Customer feedback on technology,
integration, and APIs
– Configurability and upgrades
– Code, databases, operating systems detail
– Integration
– Methods, services, and APIs
– Deployment options
– Change tooling
– Upgrade automation
Breadth of Functionality – Customer feedback on features and

functions
– Overall support of components and features
– Product support and in production
© CELENT 17
Matrix
ABC Categories Possible Factors

Customer Base and – Number of insurers running the system
Support
– New insurance clients won in the last two
years
– Number of countries where the system is

implemented
– Client feedback on implementation and

post-implementation services
– Vendor’s partners network

Source: Celent
Additional Considerations
Celent recognizes that the strength of any claims administration platform is somewhat
dependent on an insurance company’s needs and business. A solution ranked low in
Celent’s rankings may be a perfect fit for a number of insurers for various reasons: price,
business-specific functionality, target customer base, existing technology environments,
etc. For this reason, these rankings are purely the opinion of Celent. Insurers should use
them in the context of their own specific situations. Additionally:
• Celent’s ABC methodology uses a normalized scale. In some cases, this can
exaggerate quantitative differences. Its purpose is to make the graph easier to read.
• A vendor’s suitability comes down to the institution’s needs compared to the insight
offered by this analysis.
• Vendors in this analysis include Celent subscribers and nonsubscribers. We make no
distinction between how either is presented, nor does it affect our ratings.
ABC Vendor View

The Celent ABC Vendor View shows the relative position of each claims administration
system evaluated. Each vendor solution is positioned relative to others in the analysis.
Within this framework, the top performers in each ABC dimension receive a
corresponding award.
Figure 1 below displays the relative scoring of each solution, with Advanced Technology
on the horizontal axis and Breadth of Functionality on the vertical axis. The bubble size
for each vendor represents the third dimension, Customer Base and Support.
© CELENT 18
Matrix
Figure 1: Celent ABC Vendor View for North American Claims Administration Systems
Source: Celent
© CELENT 19
Claims Systems Vendors: North American Property Casualty Insurance, 2022 Edition Appian: Appian Connected Claims
APPIAN: APPIAN CONNECTED CLAIMS
Appian is a public company with sales and professional services personnel located
throughout the North America, Latin America, Africa, Middle East, Europe, and Asia-
Pacific regions. The company has over 2,100 employees, of whom 484 are available to
provide professional services/client support for their Appian Connected Claims solution.
Appian’s spend on R&D over the past two years as a percentage of total revenue
attributed to the solution is 25%. The vendor offers an annual user conference or
customer event, Appian World.
The vendor states they have had no legal issues or bankruptcy issues.
Company
Table 1: Company Snapshot
Year Founded 1999
Number of Employees 2,100+
Revenues (USD) Appian’s total revenue for 2021 was $369.3M
and subscription revenue was $263.7M
Financial Structure Public company. (NASDAQ: APPN)
Source: Vendor RFI
Table 2: Product Snapshot
Name Appian Connected Claims

Year Originally Released 2017
Current Release and Date of 22.1/2022
Release
Upgrades Client can skip multiple versions—e.g., go directly
from version 4.0 to version 7.0. They support all
versions; “no firm left behind.”
© CELENT 20
Target Market Appian targets global enterprises that need an

enterprise standard platform for rapid application
development and process automation.
Appian is used in every industry vertical, but
insurance, banking, and capital markets make up
their largest business segments. These areas are
covered by dedicated industry sales and marketing
teams, led by industry-sourced subject matter
experts.
Appian also has a global presence with 20 offices in
North America, EMEA, and APAC. Thirty-four
percent of Appian’s total revenue came from
outside the US in 2021.
Installed Base For Connected Claims Solution only:
North America: 7
EMEA: 2
APAC: 3
LATAM: 0
Notable Clients For Connected Claims Solution only:
Aon, CNA, Vermont Mutual, Ryder Truck (FNOL
Intake), Crawford & Company, Sachcontrol, Aviva,
Cigna New Zealand, Trupanion,
Florida League of Cities
Source: Vendor RFI
Celent Opinion
Appian is a new entrant to our claims report as a low code no code platform that has
built out claims functionality.
The solution has all the functionality you’d expect in a claims system – FNOL, reserving,
payments, and supports multiple channels. It includes litigation management and
subrogation management, table-driven fraud notifications built in, along with reporting
and document and note management. Adjusters can see tasks lists and get very detailed
claims overviews. The user interface is crisp and modern and makes good use of text,
white space, icons and color. To support navigation they have breadcrumbs to track
progress and multiple layers of navigation. However, the navigation is built around task
types rather than claims or customers. This isn’t unsolvable, but the solution will benefit
from reorganizing around a claimant rather than the functions supported.
Where this solution particularly distinguishes itself is in the use of AI built into the
system. The solution can assess and score the complexity of the claim, can calculate
expected repair costs for a vehicle, can calculate percentage negligence for subrogation
purposes and can create a proposed settlement offer (based on past experience within
the system. The product also has some unique features such as full NPS functionality in
the solution which can show scores not only at the transaction level, but over time. It
also includes the ability to define and track SLAs on a claim and calculate the associated
costs of the different tasks.
As a low code platform, their configuration tools are particularly strong with drag and
drop workflow, a visual screen designer, business friendly rules creation, and it is self-
documenting. It’s easy for a business user to configure – easily adding data elements,
© CELENT 21
modifying workflow, or adding workflows. It also includes all the advantages of easy
integration and cloud deployment.
The solution supports most lines of business and today is in production primarily with
smaller insurers and MGAs (although some large entities have also selected them). That
has given them the opportunity to demonstrate the flexibility of the solution and build
out key functionality. This is a solution based on a modern tech platform that is best
suited for an insurer who needs flexibility and would like to utilize data in a more granular
manner than traditionally available.
Overview
The vendor states that:
Appian Connected Claims helps insurers streamline and automate their claims
process to optimize claims handling, increase straight-through processing, reduce
claims leakage, and improve the customer experience. Built on the Appian Low-
Code Platform and deployed on the Appian Cloud, Appian Connected Claims
delivers a 360-degree view of each claim in an actionable dashboard, unifying data
from all claim systems, policy systems, and third-party applications—no data
migration needed. Each modular application in Connected Claims is designed to
target operational gaps and optimize claims handling using intelligent automation
to deliver an immediate business impact and accelerate time to value.
Key features of Appian Connected Claims include the following integrated modules:
● First Notice of Loss (FNOL): Facilitate efficient and intelligent claims

intake, improving customer experience and reducing operational costs.
● Fraud Case Management: Optimize fraud case management with a

unified view and full control of all potential fraud alerts for SIU teams.
● Claim Operations and Settlement: Provide custom workflows for different

user personas and streamline processes to speed time to close, reducing
expenses and increasing satisfaction.
● Customer Service: Gain a centralized view of claims from all CRMs and
legacy systems, delivering actionable information and enabling seamless
communication for a best-in-class customer experience.
● Litigation & Recovery Management: Deliver visibility into potential

subrogation and litigation while enabling adjusters and external
legal/recovery teams to collaborate across multiple channels.
● Field Inspections: Conduct comprehensive field inspections with intelligent

scheduling and a dedicated mobile app.
● Process Mining: Understand the data behind claim performance to

identify the ideal processes based on facts.
Key benefits include the capacity to:
● Unify claims systems and data without migration. Gain full visibility into
the claims lifecycle with a dashboard that connects existing claims and
policy systems.
© CELENT 22
● Optimize claims handling with intelligent automation. Leverage built-in

intelligent document management (IDP) and robotic process
automation (RPA) to drive efficiency.
● Reduce time and cost to implement. Leverage the speed and power of
the Appian Low-Code Platform to stay agile.
Overall Functionality
Appian offers the following modules in the core system application. Appian Connected
Claims is available on a standalone basis.
Table 3: Suite Availability

SUITE AVAILABILITY
Policy Administration 
Billing 
CRM 
Reinsurance 
Rating Engine 
Digital Tools 
Distribution Management 
Business Intelligence 
ETL Tools 
Data Hub 
Data Warehouse 
Legend: =Integrated into Claims Module;  = Separate Module available from this vendor;  = Through a
formal partnership with another vendor;  = Not available
ource: Vendor RFI
The figure below shows Appian Connected Claims’ functionality and production status of
key features for claims administration systems.
Figure 1: Key Functionality

Supported, but
In Production Not in
Not Supported
with Clients Production
Function with Clients
Desktop
User desktop / workbench  
Claims overview  
Data Services  
Upload ACORD or FNOL  
Integration and prefill with third party data  
Documents  
Includes a correspondence and forms
 
library
Can attach documents, emails, phone
 
calls, or notes
Includes a content repository and
 
document management
Notes  
Includes a notes facility  
Ability to search text within notes and
 
diaries
© CELENT 23
Other  
eSignature  
Consumer Portal  
Agent Portal  
Supervisory Tools  
Escalation based on authority  
Dashboard to manage employee’s
 
workload
Underwriter/Adjuster Assignment  
Automated underwriter assignment  
Out of office / vacation rules  
Workflow  
Automatic task generation  
FNOL/FROI  
Ability to consume FNOL from multiple
 
sources
Supports submission of additional
 
attachments
Can use party’s preferred communication
 
method
Location-based guidance at time of FNOL  
Injury Management  
Track utilization review and recertification  
Can create, document, and track special
 
programs such as return to work
Claim Investigation  
Provides capability for adjuster to explain
any coverage exclusion or endorsements  
that apply
Can display alerts  
Can document the case strategy  
Add data fields for investigation details  
Automatic ordering of third party data  
Reserving  
Ability to specify automatic default initial
 
reserves based on business rules
Multiple levels of reserve categories  
Aggregate tracking (erosion of policy
 
limits)
Deductible Tracking  
Payments  
Recurring payments  
Multiple pay parties (e.g., garnishments)  
Subrogation and Recoveries  
Separate tasks, workflow, diaries, and
business rules for subrogated cases
 
Fraud  
Workflows specific to fraud and special
 
investigations
Litigation Management  
Separate tasks, workflow, diaries, and
 
business rules for litigated cases
Vendor Management  
Vendor management tools  
Reinsurance  
Manually tag a claim when reinsurance
 
applies
Automatically identify claims subject to
 
reinsurance
Catastrophe  
Ability to define catastrophes (by peril,
 
geography, date, or other criteria)
Automatic identification of cat claims  
Additional LOB Functionality  
Functionality specific to auto insurance  
© CELENT 24
Functionality specific to property

insurance
 
Functionality specific to liability insurance  
Functionality specific to workers
compensation insurance
 
TPA  
Ability to track hours/activities  
Ability to manage different fee schedules  
Support for Lloyd’s Claims Processes  
Support for the Electronic Claims File
 
(ECF2)
Support for ECF Write Back  
 
= Available out of the box = Configurable through a scripting = Under development / On
language/coding roadmap
= Configurable using simple tools  = Available with integration to a = Could developwould be
for business user third-party solution considered customization
 = Configurable using simple = Available with integration to a = Not available / Not applicable
tools for IT user separate module provided by this
vendor
Source: Vendor RFI
Reporting Features
The Appian platform includes a built-in reporting and analytics framework that
organizations can use to gain real time visibility into business operations, track progress
against KPIs and bottlenecks, and build business reports.
Appian reports use data from the active processes of a process model, the tasks assigned
to certain users or groups, or from specific process instances. Appian can also create real
time business reports from business data retrieved via integrations of systems including
web services, databases, and ERPs such as SAP applications, bespoke systems, and other
external data sources.
Appian’s reporting components support the ability to drill down to more detail, both
from the tabular view and the graphical view. Reports can be converted from one type to
another as required.
The reports support real time dynamic interaction where information such as search
strings and drop-down filters can be used to modify the report contents. Graphical
reporting tools (charts, graphs, etc.) and report scheduling are available. Appian provides
the following report types: ad hoc, predefined reports, customized reporting, historical as
of reporting, real time reporting, and period end reporting.
Internationalization
Appian Connected Claims can support multiple currencies: Argentine Peso (ARS),
Australian Dollar (AUD), Brazilian Real (BRL), British Pound Sterling (GBP), Canadian Dollar
(CAD), Chinese Yuan (CNY)*, Czech Koruna (CZK), Danish Krone (DKK), Euro (EUR), Hong
Kong Dollar (HKD), Hungarian Forint (HUF), Indian Rupee (INR), Japanese Yen (JPY),
Mexican Peso (MXN), New Taiwan Dollar (TWD), New Zealand Dollar (NZD), Norwegian
Krone (NOK), Polish Zloty (PLN), Russian Ruble (RUB), Singapore Dollar (SGD), South
African Rand (ZAR), South Korean Won (KRW), Swedish Krona (SEK), Swiss Franc (CHF),
Thai Baht (THB), and the US Dollar (USD), among others. Appian can support multiple
languages too. Appian’s internationalization capabilities permit platform administrators
to set primary languages, time zones, currencies, and calendars. Users may set their
language preference out of a list of supported languages enabled by the administrator.
© CELENT 25
Designers may use localization dictionaries to add support for multiple languages in their
applications, or harness AI translation integrations to support over 150+ languages.
Appian supports the following language versions OOTB: Arabic, Chinese, Dutch, English,
French, German, Greek, Italian, Japanese, Korean, Polish, Portuguese, Russian, Spanish,
and Swedish.
Customer Base
Appian Connected Claims has 12 total customers. Seven are in North America, two are in
EMEA, and three are in Asia-Pacific.
Customer Feedback
Three clients provided feedback on Appian. All clients are based in North America and
have been using the system for 1 to 3 years.
Clients rated Appian favorably overall. For functionality, while not all respondents graded
every feature, respondents gave top scores to reserving, payments, and supervisory
tools. Within technology, all aspects were given 4’s or 5’s by each respondent. The
highest scoring items were the flexibility of the data model and the vendor's timing in
improving technical performance through new releases and fixes.
Clients have rated all aspects of integration equally at a 4 for the vendor. Regarding their
implementation experience, all aspects were rated as a 5 except continuity with the
implementation team - did the core team stay engaged through to implementation came
in at a 4. Finally, in the area of ongoing system support, all aspects of support were rated
5’s except consistently meeting SLAs, and communication - proactive communication of
issues and changes - which both came in as 4’s.
When asked what they liked best, one client appreciated, “The ability to maintain close
relationships with management and project team. [The team} is very responsive and they
understand the Appian platform well.” Another client said, “The low code makes it very
easy to train and utilize for our business users. It also allows new features to be built
quickly for faster turnaround times. The vendor is always easy to work with and
understanding of our business needs. We tend to push them out of their comfort zones
and we all learn more from it.” And the last client said, “The team was knowledgeable
and responsive from the first. They learned our business and listened well. Any issues were
resolved quickly and creatively. The experience was very positive before, during, and post
project. This project was first of its kind for [our organization] with many internal
constituents- users being internal, external- underwriting, claims and billing.”
Suggested improvements from clients included, “Minor issues with international travel,
especially with COVID. Some staff had difficulty getting back in the country. They made it
work nonetheless.” Another client said, “Support can be tough to communicate with so I
generally request a phone call rather than multiple back and forth comments.” And the
last suggestion was, “ Nothing. Work is always ongoing to maximize the platform. I am
now looking to gain funding to add an external portal element for customers/
brokers/clients to self-serve some requests and to view status of work/requests.”
© CELENT 26
Figure 3: Customer Feedback
Source: Celent 2021 PC PAS Customer Feedback Survey
Lines of Business Supported

Table 4: Lines of Business Supported
P&C LOBS Availability
Personal Auto 
Homeowners/Home 
Renters/Contents 
Umbrella 
Commercial Auto 
Commercial Property 
Commercial Liability 
Workers’ Compensation 
Medical Professional Liability 
Other Professional Liability 
Business Owners Policy (BOP) 
Surety & Fidelity 
Excess Policies 
Directors and Officers Liability 
Legend: = In production;  = Supported but not in production; = Not supported
Source: Vendor RFI
© CELENT 27
Technology
Appian is a modern cloud platform with a containerized, microservice
architecture orchestrated on Kubernetes.
At a very high level, Appian is composed of six main software components:
1) A front end server hosting the Appian web application.
2) A set of backend in-memory database engines.
3) One or more search servers.
4) A relational database hosting Appian internal data and metadata, plus any
additional relational databases hosting Appian business data.
5) A data server to store application data and metadata.
6) An internal messaging service that relays messages between different

components of Appian.
The Appian web application serves requests from users’ browsers or mobile apps and is
primarily responsible for all end user, designer, and administrator web interface features.
The Appian engines contain metadata for most Appian objects created by the designers
(groups, process models, rules, constants, knowledge centers, etc.) as well as runtime
data created by users or processes (e.g., process instances, document metadata). Data
stored in the engines is accessed and updated by the web application.
The search server provides additional support for application features like viewing recent
user activity in the Admin Console.
The Appian Data Source is a relational database that stores Appian data and metadata
such as news posts, CDT and Record Type definitions, and Admin Console properties.
Additional business data sources can be configured to store and access business data
from Appian applications.
The data server is Appian’s next-generation data persistence layer. It provides better
performance, higher reliability, and increased security for application data. Currently, the
data server is used to store user-saved filters and serves as the storage layer for synced
records.
The last major technology change was implemented in version 2021.
The primary UI is 100% browser-based with a plug-in (e.g., Flash, touchscreens). The
vendor does not have plans to change the framework for the future.
Technology details for Appian Connected Claims are provided in the table below.
Table 5: Technology Options

Technology Options Responses
Code Base 100% Java
JEE/Java version support: Appian bundles
Operating Systems
OpenJDK 8 and also supports Oracle JDK 8
© CELENT 28

.NET version support: Not supported
Available operating systems: Unix-Linux,
Windows,
The system uses/supports Java servers
Servers Supported
Tomcat, JRun, other Java servers
DB2, Kdb+, MongoDB, NoSQL, Oracle,
Databases
PostgreSQL, SQL
Scalability
2,400,000+ users.
Scalability Metrics: During the peak of the
Iraq/Afghanistan conflicts, a Department
of Defense agency sustained more than
2.4 million active users and more than
unique 100,000 logins in a 24-hour
period. More recently, Appian has
government and commercial entities with
8,000–14,000 concurrent user sessions
processing hundreds of thousands of
transactions per day.
System Performance: Appian’s
architecture is designed to operate in the
most demanding enterprise
environments. Individual Appian
customer deployments range from as few
as 100 users to as many as millions of
active users around the world.
Appian can be deployed on a wide variety
of enterprise server topologies, including
physical and virtual, clustered or
distributed, on premises (installed behind
the customer’s firewall) or cloud
(subscription-based, hosted, Platform-as-
a-Service [PaaS]). Applications built on
the Appian platform are portable
between on-premises and cloud
deployments.
Deployment Models Eighty percent of clients use Appian's
managed Cloud offering running on AWS
(rest are either on-prem, hybrid, or other
public cloud), with best-in-class support
for:
Scalability: Auto-scaling environments in a

containerized platform architecture,
orchestrated on Kubernetes.
Availability: 21 regions and 63 availability

zones worldwide, with more being added
each year.
© CELENT 29

Reliability: 99.99% contractual uptime
SLA, with unmatched one-minute RPO
and 15-minute RTO.
Upgrades: Automatic upgrades each

quarter, with full backward compatibility
and support for latest
devices/experiences.
Security: The deepest set of platform

security certifications in the low-code
market, easily verified in their public Trust
Center.
Extensibility: Managed SDKs to extend

Appian apps with custom
components/integrations and publish to
public AppMarket.
Hosting Details
Number of instances: Not Reported
Maximum number of clients running on
one instance: Not Reported
Public Cloud Options AWS. Customers may also self-deploy on
Google Cloud or Microsoft Azure.
Source: Vendor RFI
Data
The solution supports industry standard data model schemas. Appian can be used in
conjunction with any industry data model. The low code data flexibility allows the use of
any data model or even uses multiple data models. The database was designed from the
ground up for this product. Clients can change the data model through a low code data
approach, including:
• Visual modeling tools to define data models.
• Auto discovery of data models from databases like SQL Server, Oracle, IBM,
MySQL, and MariaDB as well as Salesforce or Web Services. The data model can
be released to the client, can be easily published to a client’s data model, and
can map to an intermediate format to share with a client (such as an industry
standard). Appian provides a graphic interface to add or update fields and
tables. It is also possible to make relationships that are coming from other
systems.
Appian can auto-detect data model changes from underlying databases and auto update
Appian with the latest changes. Customers can implement their data models on the
Appian Platform. They can reuse existing data models and/or use industry standard data
models.
© CELENT 30
Integrations
Appian provides Web services; XML, not through web services; HTML; HTTP; RESTful
HTTP-style services; JSON format; MQSeries, JMS or similar queue technology; custom
APIs; flat files; native messaging; and other integration methods. External systems can
trigger events in the system which can be responded to by a workflow or business rule.
Public API integrations: Appian provides packaged no-code connections to 150+ systems
including Salesforce, SAP, Microsoft Office 365, Microsoft Dynamics, SharePoint, Power
BI, VISA, MasterCard, ADVAM, Intuit QuickBooks, Microsoft Azure LUIS, Microsoft QnA
Maker, Google AI, Amazon Machine Learning, Amazon S3, Amazon Connect, Amazon Lex,
Amazon Rekognition, Snowflake, JIRA, Dropbox, Box, DocuSign, MongoDB, Google Drive,
Slack, Twilio, Temasys, Google Maps, SurveyMonkey, Oracle Siebel, Google Sheets,
GitHub, HubSpot, ABBYY, Vonage (formerly Nexmo), PubNub, UiPath, Blue Prism,
Automation Anywhere, and more. Customers can integrate these systems into their
Appian applications in minutes via a visual, cascading design environment, without having
to go through complex API documentation.
API details for the vendor are as follows:
The API is documented. External systems can trigger an event in the system which can be
responded to by a workflow or business rules system. API management supports local or
global standards, such as ACORD application creation and rendering. API sample codes
are available to clients. An API developer portal is available for support and descriptions.
An API testing portal and the ability to use scripts on website is available. The system
allows API publishing in SOAP, REST, JSON, and XML-style services as APIs. API version
management is available. Access to the APIs is managed and use of APIs tracked by
developers. Training in extending the system is offered.
● Appian provides documentation and training for API integrations.
● Appian provides free online training and paid (virtual) classroom training with
live instructors and numerous full and short subject courses. This includes
training on creating and managing API Integration objects.
● Appian also provides three levels of credential exams:
1) Appian Certified Associate Developer
2) Appian Certified Senior Developer
3) Appian Certified Lead Developer
● Appian also provides free online training for each quarterly release of the
platform so developers can stay up to date on latest features. They also provide
their free Appian Playbook & Delivery Methodology, which serve as complete
guides to running an Appian COE and planning/executing Appian dev projects.
● Training and credentials are part of Appian Community, their central public hub
for learning, documentation, app marketplace downloads, and product support
(knowledge base, discussion forums, and the like).
The table below shows available products pre-integrated with Appian Connected Claims.
© CELENT 31
Table 6: Insurance Pre-Integrations

Integration
Address verification tools: Pitney Bowes

Document management systems: Box, Dropbox, CMIS, Google Drive, Microsoft
OneDrive, AWS S3, and more.
Source: Vendor RFI
Configuration
Table 7: Approach to Accelerating Product Change
Approach to Accelerating Product Change Availability
Customers can copy and paste between 

products
Customers can define reusable parts that can 

be linked together
The system uses inheritance to help define 

products
The system uses reusable components, 

inheritance, and other schemes (explained
below)
Other 
Source: Vendor RFI
All Appian design objects are independent, reusable, and version controlled, enabling
flexible change, impact analysis, and testing.
Appian provides a set of DevSecOps features for managing application development,

testing, deployment, and monitoring. This includes:
- Connected DEV, TEST, and PROD environments with automated/one-click

deployment.
- Automation Planner tool to capture business requirements, plan new

projects, measure ROI, and prioritize accordingly.
- Automatic scans for misconfigured objects, gaps, test coverage, and security
coverage during deployment.
- Centralized test case management.
- Deployment guardrails on who can move apps into a new environment and
when.
- Automatic impact analysis and dependency scans as objects are

changed/deleted.
- Visual DIFF analysis showing how objects have been changed across
environments, with full change management/version control.
© CELENT 32
- Conflict resolution and peer reviews for design objects.
- Built-in design recommendations and unit testing during app development.
- Detailed performance monitoring for all apps and objects.
- Automated post-deployment processes.
In addition to native DevSecOps features, Appian also integrates with common third
party SDLC management tools, such as JIRA, Git, Bamboo, and Jenkins, and third party
test automation suites like Cucumber, Selenium, JMeter, Locust, and FitNesse.
All changes can happen without a restart of the server.
Table 8: Approach to System Changes

Approach to System Changes Availability
Business Rule Definition 
Data Definition 
Table Maintenance, List of Values, etc. 
Interface Definition 
Product Definition 
Role-Based Security, Access Control, and Authorizations 
Screen Definition 
Workflow Definition 
Legend: = Configurable via tools for business users;  = Configurable via tools for IT users;  = Configurable
via the vendor;  = Configurable via scripting;  = Coding required;  = Not available
Source: Vendor RFI
Security
Appian invests in quarterly third party security audits and in maintaining the following
security certifications in the low-code market:
ISO27001, ISO27017, ISO27018, HiTRUST, DISA Level 2, DISA Level 4, DISA IL5, FedRamp
Level 2, GDPR, HIPAA, SOC1/2/3, PCI-DSS, FISMA, UK G-Cloud, GxP, Cloud Security
Alliance, EU-US and Swiss-US Privacy Shield Frameworks, FDA, 508/VPAT, ENS High-Level,
and Qualys SSL Labs.
In addition to these certifications, Appian's security program includes the following:
Security Controls: Align to leading NIST, PCI and other frameworks via access
controls and authentication, audits, contingency planning, incident response,
personnel and physical security, risk assessment, system acquisition & integrity,
and systems communication protection.
Authentication: SAML, LDAP, Active Directory. PCI DSS compliant login and
password management features. Virtual Private Network (VPN) for extending
client’s data center. Bring Client’s Own Key (BYOK) to secure the disk that stores
client’s data. Role-based, delegated administration platform security.
© CELENT 33
Storage & Tenancy Protocol: Local geography hosting, data segmentation,

application segmentation, data replication within the same region, tenant
instance isolation, regulatory compliance.
Continuous Monitoring: Continuous security monitoring for advanced threats,

security notifications, performance and health, platform response times,
uptime/availability, compliance auditing.
Defense-in-Depth Protection: Multiple layers of security which apply defense-in-

depth security strategy to the global infrastructure, including network intrusion
detection system (IDS), host IDS, web application firewall, network layer
firewalls, file integrity monitoring, strict access controls between infrastructure
tiers.
Encryption & Data Isolation: Security of data in transit and at rest using strong
encryption via transport Layer Security (TLS) for end-user connections; disk
encryption to secure data at rest; customer data backups are encrypted, secure
connection channels with customer data sources; each customer is allocated
virtual server(s) and virtual drive(s) for their application server; the Appian
application and database use are never shared with other customers.
Vulnerability Testing: Appian contracts an independent expert security firm to

perform tests on Appian Cloud, including vulnerability scanning, internal
penetration testing, external penetration testing, and isolation architecture
exploitation. Customers are encouraged to perform their own vulnerability
testing. Documentation of quarterly security audits can be available upon
request.
Personnel: Appian Cloud personnel are located alongside their services and
engineering staff in the USA, Australia, and the United Kingdom. Additional
activities include a formal screening process that includes a required background
check; extensive cloud security training; and continuous training on operational
practices.
Security Incident Reporting: Appian takes security seriously. They encourage

reporting security vulnerabilities and security incidents to Appian. All
submissions are investigated by the Security Incident Response Team. Appian
takes appropriate action in the form of hotfixes, upgrades, or published
mitigation information. Appian notifies affected customers.
The Payment Card Industry (PCI) Security Standards Council offers standards to enhance
payment card data security providing a framework for developing a robust payment card
data security process, including prevention, detection, and appropriate handling of
security incidents. The vendor is PCI compliant. Customers can leverage Appian Cloud’s
PCI-DSS certification to reduce their own PCI compliance complexity after agreeing to the
Appian Cloud PCI-DSS terms. Appian Cloud has been assessed by an external independent
auditor and is compliant with PCI-DSS.
One-time passwords, flexible user permissioning, out-of-band identification, security

tokens/pins, biometric security support, multi-factor authentication, and federated
identity support are available as authentication factors for internal and external users.
© CELENT 34
Partnerships
Table 9: Partnerships
Type of Partnership Partner Vendor
System Integrators Appian has a global network of 573

delivery partners, including global
alliances with KPMG, Accenture, Deloitte,
Atos, Wipro, Cognizant, PWC, HCL,
Capgemini, TCS, Perficient, Infosys, EPAM,
and Persistent.
All of these SIs have dedicated Appian

COEs. There are 15,000+ certified
individuals in these orgs for Appian
implementation & support services.
In addition to providing implementation

and support services, many of these
partners offer prebuilt solutions created
on the Appian platform, engage in joint
go-to-market activities, and/or sponsor
Appian events. Many of these partner-
build solutions are listed on their public
AppMarket.
Conversion Partners Conversion tools are provided by Tata

Consultancy Services and Crystal System
respectively. A large number of Appian’s
system integrator partners also provide
services to convert applications into the
Appian platform.
Functionality Partners Appian has the following technology

partners:
InsurTech/FinTech: Shift, Swiss Re, Jumio,
Galaxy AI, SWIFT
Cloud: AWS, Microsoft Azure, Google
Artificial Intelligence: Google, Microsoft
Azure, AWS, Pyze
Omnichannel Customer Engagement:
Twilio, Genesys, Temasys
Document Processing/Management:
DocuSign, Box, Dropbox, ABBYY
Process/Task Mining: Celonis, StereoLogic
RPA: UiPath, Automation Anywhere, Blue
Prism
© CELENT 35
Miscellaneous: SAP, Nullafi, Esri,

Everywell, and more
Fintech Partners InsurTech/FinTech: Shift, Swiss Re, Jumio,

Galaxy AI, SWIFT, Dow Jones, Bloomberg,
Quantexa, Dun & Bradstreet, NorthRow,
Companies House, OFAC
Accreditations and Certifications Appian invests millions each year in

proactive quarterly security audits and
has the deepest set of platform security
certifications in the market, including
ISO27001, ISO27017, ISO27018, HiTRUST,
DISA Level 2, DISA Level 4, DISA IL5,
FedRamp Level 2, GDPR, HIPAA,
SOC1/2/3, PCI-DSS, FISMA, UK G-Cloud,
GxP, Cloud Security Alliance, EU-US and
Swiss-US Privacy Shield Frameworks, FDA,
508/VPAT, ENS High-Level, and Qualys SSL
Labs.
Source: Vendor RFI
© CELENT 36
Implementation and Support

Table 10: Implementation and Support
Function Approach
Employees Available Appian has 484 staff dedicated to customer success.
/Average Experience
Level (Years) Appian is primarily a software organization, with 72% of
all revenue derived from software. The vast majority of
implementation services in context to Appian software is
delivered by Appian’s business partners, such as:
● KPMG
● Accenture
● Deloitte
● Cognizant
● TCS
● etc.
Locations of Employees Appian has employees in North America, EMEA, APAC,
LATAM.
Resource Breakdown Resource breakdown varies from case to case.
(Vendor, Client, System
Integrator) The vast majority of services for Appian software are
delivered by Appian’s business partners.
Use of Third Parties Third party system implementors do most of the
vendor's implementations.
Conversion Options: The vendor can handle conversions
themselves or use a third party depending on the
customer’s needs.
Average Time to Initial Implementation: 1 to 3 months
Implementation
2nd and subsequent LOBs: 1 to 3 months
2nd and subsequent states/jurisdictions: 1 to 3 months
Preferred Implementation Appian enables agile implementations with iterative
Approach sprint cycles to deploy initial applications.
Methodology
Appian has a defined delivery methodology with
published best practices on starting and then scaling an
Appian development program. These online resources
are freely available as part of Appian Community, their
central public hub for training, certifications,
documentation, and support.
Appian Guarantee
The Appian Guarantee is their most popular services
package for new clients. Through this program, Appian
guarantees that a new client will have their first
application live in just eight weeks, and that any
technical resources brought to that project will become
certified, productive Appian developers in two weeks.
This program, which can be delivered by either Appian’s
own Customer Success team or by their partners,
© CELENT 37
Function Approach
launches successful development on Appian with a high-
impact, product-ready application. It is critical for
building a self-sufficient Appian COE, ensuring that
clients do not have to rely exclusively on Appian or
partner services when they are ready to scale their use of
the platform. The Appian Guarantee is one of their most
powerful and differentiated assets for demonstrating the
power, speed, and accessibility of their low-code
automation platform.
Sla Availability SLA Uptime of 99.99%
Appian offers a High Availability offering with a one-
minute RPO and 15-minute RTO.
Source: Vendor RFI
Training
Appian provides free online training and paid (virtual) classroom training with live
instructors and numerous full and short subject courses. This includes training on creating
and managing API Integration objects.
Appian also provides three levels of credential exams:
1) Appian Certified Associate Developer
2) Appian Certified Senior Developer
3) Appian Certified Lead Developer
Further, Appian provides free online training for each quarterly release of the platform so
developers can stay up to date on latest features. They also provide their free Appian
Playbook & Delivery Methodology, which serves as a complete guide to running an
Appian COE and planning/executing Appian dev projects.
Training and credentials are part of Appian Community, their central public hub for
learning, documentation, app marketplace downloads, and product support (knowledge
base, discussion forums, and so on).
New training modules are periodically added, and online video training is available.
Pricing
Table 11: Pricing Models
Pricing Models Available: Subscription License: Connected Claims

has a separate license.
Factors Used to Determine Pricing: Usage-based factors: Number of

concurrent users, Number of total or
named users, Per active user/seat, Per
© CELENT 38
user/seat, Application Usage Scope,

Developer Seats.
Connected Claims pricing is based on
modules purchased, claims volume
(annual claim count) and product lines—
Life, Personal Insurance, Commercial
Insurance
Other: Flat pricing, Freemium entry level
followed by a standard pricing plan
Source: Vendor RFI
The following table shows the average total costs of the vendor’s current client base. This
includes costs associated with the software license, initial installation, customization,
annual maintenance, and training in the first year. It also estimates the remaining costs
for full implementation, including license fees, maintenance, customization, and other
fees.
Table 12: Pricing Models: 5-Year Pricing Estimates
Average Total Licensing Implementation All Other

Costs
Average Year 1 US$100,001 to US$100,001 to US$100,001 to

Costs US$250,000 US$250,000 US$250,000
Average Year 2 Not Disclosed Not Disclosed Not Disclosed

and Beyond
Remaining Costs
Source: Vendor RFI
© CELENT 39
Claims Systems Vendors: North American Property Casualty Insurance, 2022 Edition Concluding Thoughts
CONCLUDING THOUGHTS
For Insurers
There is no “one-size-fits-all” claims solution, but insurers can take comfort in the fact
that there are myriad options to fit almost any set of requirements. An insurer seeking a
new core claims system should begin the process by looking inward. Every insurer has its
unique mix of lines of business, geography, staff capabilities, business objectives, and
financial resources. This unique combination and the organization’s risk appetite will
influence the list of vendors for consideration.
Some vendors are a better fit for an insurance company with a large IT group that is
deeply proficient with the most modern platforms and tools. Other vendors are a better
fit for an insurance company with a small IT group that wants the vendor to take a
leading role in maintaining and supporting its applications.
Most core claims systems bring some level of out-of-the-box functionality for various
lines of business and operating models. Many systems offer powerful configuration tools
to build capabilities for both known and future requirements.
We recommend that insurers that are looking for a claims system narrow their choices by
focusing on four areas:
• The functionality needed and available out of the box for the lines of business and
states desired. Check to see what is actually in production.
• The technology—the integration framework, the overall architecture, and the
configuration tools and environment.
• The vendor stability, knowledge, and investment in the solution.
• Implementation and support capabilities and experience.
For Vendors
There has been considerable investment among solution providers to differentiate
themselves from their peers. Many of today’s claims admin systems are mature. The
solutions deliver robust functionality, improve configuration tools, and are more
connected with SOA. Cloud implementation is also becoming table stakes.
Although these trends are beneficial for insurers, they make the competitive challenges
facing vendors much more daunting.
Celent recommends vendors differentiate themselves by:
• Focusing on improving usability for both new and experienced users and managers.
• Emphasizing ease of use.
• Building an ecosystem of claims-focused established tech solutions and insurtechs
that integrate with the claims admin solution.
• Making implementation faster and less expensive.
© CELENT 40
Claims Systems Vendors: North American Property Casualty Insurance, 2022 Edition Concluding Thoughts
• Continuing to move to open APIs and other integration frameworks to drive the easy
orchestration of processes and data across external digital capabilities.
• Continuing to build out configuration environments to put change controls in the
hands of the carriers.
© CELENT 41
Claims Systems Vendors: North American Property Casualty Insurance, 2022 Edition Leveraging Celent’s Expertise
LEVERAGING CELENT’S EXPERTISE
If you found this report valuable, you might consider engaging with Celent for
custom analysis and research. Our collective experience and the knowledge we
gained while working on this report can help you streamline the creation,
refinement, or execution of your strategies.
Support for Financial Institutions

Typical projects we support include:
Vendor short listing and selection. We perform discovery specific to you and
your business to better understand your unique needs. We then create and
administer a custom RFI to selected vendors to assist you in making rapid and
accurate vendor choices.
Business practice evaluations. We spend time evaluating your business
processes and requirements. Based on our knowledge of the market, we identify
potential process or technology constraints and provide clear insights that will
help you implement industry best practices.
IT and business strategy creation. We collect perspectives from your executive
team, your front line business and IT staff, and your customers. We then analyze
your current position, institutional capabilities, and technology against your
goals. If necessary, we help you reformulate your technology and business plans
to address short-term and long-term needs.
Support for Vendors

We provide services that help you refine your product and service offerings.
Examples include:
Product and service strategy evaluation. We help you assess your market
position in terms of functionality, technology, and services. Our strategy
workshops will help you target the right customers and map your offerings to
their needs.
Market messaging and collateral review. Based on our extensive experience
with your potential clients, we assess your marketing and sales materials—
including your website and any collateral.
© CELENT 42
Claims Systems Vendors: North American Property Casualty Insurance, 2022 Edition Related Celent Research
RELATED CELENT RESEARCH
Exploring The Wide World of P&C Claims Insurtechs

February 2022
North American Property/ Casualty 2022 CIO Pressures and Priorities
January 2022
What Makes a Cloud a Good Cloud?
December 2021
Photo Finish: Seeing is Believing
December 2021
Technology Trends Previsory, Property & Casualty Insurance, 2022 Edition
November 2021
Applying Behavioral Economics to Insurance
September 2021
Unlocking The Value of Touchless Claims
August 2021
Claims Systems: EMEA Property Casualty Edition
April 2021
Claims Systems Vendors: Asia Pacific (APAC) Property & Casualty 2020 Edition
July 2020
Insurance Claims Payments as a Service: A Primer
June 2020
Data Science in Claims- Digital Acceleration and Customer Delight
June 2020
© CELENT 43
COPYRIGHT NOTICE
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This report is not a substitute for tailored professional advice on how a specific financial institution should execute its strategy. This report is
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changes, events or conditions, which occur subsequent to the date hereof.
For more information, please contact [email protected] or:
Karlyn Carnahan [email protected]
Donald Light [email protected]
Andrew Schwartz [email protected]
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What is the report about?

What is the report about?

What company is being profiled in the report?

What company is being profiled in the report?

Celent Claims System

Vendors: North American

April 22, 2022

Built on the Appian Low-Code Platform and deployed on the Appian

Find out more in the report.

Karlyn Carnahan, Donald Light, and Andrew Schwartz

Executive Summary .......................................................................................................... 3

Core Claims Systems: Definition and Functionality ............................................................ 5

Report Methodology ...................................................................................................... 13

Celent’s ABC Vendor View and Technical Capability Matrix ............................................. 17

Appian: Appian Connected Claims .................................................................................. 20

Concluding Thoughts ...................................................................................................... 40

Leveraging Celent’s Expertise.......................................................................................... 42

Related Celent Research ................................................................................................. 43

Copyright Notice ............................................................................................................ 44

This report provides an overview of the claims administration systems available

CORE CLAIMS SYSTEMS: DEFINITION AND

• Evaluate and analyze the circumstances of the claim.

• Make decisions and take actions, including payment.

• Execute transactions and preserve a record.

Figure 1: Core Claims Systems Layers of Functionality

Supervisory Management Tools: Claims supervisors look for a variety of capabilities to

escalation procedures to route claims easily when additional authority is needed.

Catastrophe Management: All carriers are vulnerable to a wide variety of catastrophes.

Reinsurance: Like catastrophe management, systems handle reinsurance in a variety of

Workers’ Compensation Rehabilitation Management: Functionality specific to workers’

Release Management: Some solutions include workflow capabilities to handle the

Implementation: Vendors use a wide variety of implementation methodologies. Some

In this report, Celent’s objective is to include as many as possible of the leading

Criteria for Inclusion

About the Profiles

The profiles are presented in alphabetical order.

Each participating vendor completed an online RFI in Celent’s VendorMatch/RFX

Customer Reference Feedback

Table 2: Customer Feedback Ratings

Questions Rating Included in the Average

Questions Rating Included in the Average

CELENT’S ABC VENDOR VIEW AND TECHNICAL

Customer Base and Support

Table 1: Examples of Factors Used in Celent Claims Administration System ABC

– Configurability and upgrades

– Code, databases, operating systems detail

– Methods, services, and APIs

Breadth of Functionality – Customer feedback on features and

– Overall support of components and features

– Product support and in production

ABC Categories Possible Factors

– Number of countries where the system is

– Client feedback on implementation and

– Vendor’s partners network

ABC Vendor View

APPIAN: APPIAN CONNECTED CLAIMS

Table 2: Product Snapshot

Name Appian Connected Claims

Target Market Appian targets global enterprises that need an

● First Notice of Loss (FNOL): Facilitate efficient and intelligent claims