BUYING GUIDE
How to Evaluate Claims Software in 2026
Most evaluations are decided before the first demo, because whoever writes the criteria decides what gets judged. Here is a criteria set built around the work, written so you can put the same questions to everyone on your list.
No vendor is named on this page until the last section. The framework is only worth using if it survives being pointed at whoever else is on your shortlist.
WHAT AN EVALUATION SHOULD TEST
- Handled to PlanDid the required steps happen on time
- Reserves DisciplinedWho moved it, when, and why
- Delegation ConsistentSame standard through every partner
- Portfolio Drift VisibleEarly, not at renewal
- Governance ProvableFrom the system, not from memory
BEFORE THE CRITERIA
Who should run the evaluation?
Claims people. If you had a cold you would not go to your mechanic, and a claims system should not be chosen by people who will never work a claim.
IT belongs in the room for the security, integration, and data questions. The claims team belongs at the head of the table, because they know where the handoffs break, where the duplicate entry hides, and which reports get rebuilt by hand every month.
Settle that before criteria, because the answer decides who gets to say a demo went well.
THE SECOND HABIT
A feature checklist tells you almost nothing
Vendors can answer yes to nearly any feature question, and a yes tells you nothing about whether the capability fits how your files actually move.
- Claims do not happen inside systems. They happen across organizations, across teams, partners, programs, and reporting obligations.
- Judge software by how well it moves claims forward, not just how well it stores them.
THE FIVE QUESTIONS
What the Evaluation Actually Has to Test
You are accountable for claims you cannot always fully see, across people and partners you do not control. The system's job is to make these five answers visible without a fire drill, so ask each vendor to show you the answer on one of your own files rather than describe it.
01 · TO PLAN
Are claims being handled to plan?
Every client, program, or carrier relationship comes with a handling standard: contact windows, reserve reviews, report intervals, escalation triggers. Ask each vendor to load one of your own scenarios into a sandbox and show, on that file, whether the required steps happened on time. If the answer involves exporting to a spreadsheet, the system stores claims. It does not oversee them.
02 · RESERVES
Are reserves disciplined?
Reserving is a judgment call, and judgment needs a record. The system should show when each reserve was last reviewed, who moved it, and why, with the history on the file rather than in an email thread. Ask to watch a reserve change end to end, including what management sees the next morning.
03 · DELEGATED
Is delegated handling consistent?
The moment handling is delegated, to a third-party administrator, an adjusting firm, or a coverholder's claims team, consistency becomes the whole game. Ask how authority limits are enforced, and specifically whether a file keeps the limit that was in force on the day the work was done or picks up whatever the limit is today. An audit of a two-year-old decision is judged against the older answer.
04 · DRIFT
Is the portfolio drifting?
Individual files can each look fine while the book quietly moves: severity creeping in one program, cycle times stretching in one region, a litigation rate climbing quarter over quarter. Ask what the system surfaces at the program and portfolio level, and how early. Finding drift at renewal is not finding it.
05 · EVIDENCE
Can governance be proven on demand?
Regulators, auditors, and capacity providers are done accepting attestation in place of evidence. The test is simple to run, and it is the one to run last, when the vendor thinks the demo is over: pick a closed claim and ask them to produce, from the system alone, who did what, when, under what authority, and against which standard. If assembling that story takes a working day, what you are looking at is a filing cabinet with a login.
THE CRITERIA
Which Capabilities Belong on the List
Nine areas, chosen because they separate systems quickly. Watch each one in a demo running your own scenarios rather than ticking boxes on a features grid, and weight them against your own book before you send anything out.
| Criterion | What to Test For | Weighs Most For |
|---|---|---|
| 01 · Workflow | Configurable to your handling standards without custom code, with deadlines and escalations the system enforces rather than suggests. Watch for over-customization too. A system that needs everything built for you is a project, not a product. | Everyone. Decisive for adjusting firms and TPAs working to several clients' standards at once. |
| 02 · Policy and Coverage Data | Policy terms, limits, deductibles, and endorsements sitting on the file at first notice of loss, fed by integration rather than retyped by the adjuster. Ask what happens when the policy system is one you did not buy from this vendor, and who owns the mapping when a form or endorsement changes. | MGAs and carriers, where the policy system is your own. Lighter for a TPA handed coverage by its client. |
| 03 · Security | A current SOC 2 Type 2 report, with the auditor named and the examination period stated, plus role-based access and field-level audit trails. Ask how the report is released and on what terms, because that answer varies by vendor and procurement will need it in the file. | Everyone. Heaviest where a carrier, a capacity provider, or a client audits you. |
| 04 · Digital Transactions | First notice of loss, documents, signatures, and payments handled digitally end to end, so nothing falls into an inbox between steps. | Books with direct claimant contact at volume, most often carriers and the TPAs handling first-party lines for them. |
| 05 · Data Exchange Between Parties | One claim is worked by several organizations, each from its own system. Ask how data moves between them: documented APIs or a supported feed, who maintains the mapping, what happens when a partner's format changes, and whether the exchange is logged where an auditor can see it. A vendor who answers this with "we export a spreadsheet" has told you what the integration is. | Independent adjusters and TPAs working claims for a principal, and the MGA or carrier overseeing them. |
| 06 · Assignment | Claims routed on criteria you control, to desks or to field adjusters, with workloads visible. Surge is the real test. Ask what assignment looks like in a catastrophe month, not a quiet one. | Independent adjusters, and any property book exposed to catastrophe. |
| 07 · Finance and Payment Integration | Payments issued from the claim and posted cleanly to your accounting system or general ledger. Rekeying into finance is where duplicate payments, posting errors, and reconciliation breaks live, and it is the first place an auditor pulls a sample. | TPAs paying from client funds, and carriers, captives, and self-insureds paying from their own. |
| 08 · Statutory and Industry Reporting | The obligations your book actually carries: Medicare Secondary Payer reporting under Section 111 where liability files apply, industry claim-history submission, special investigation referral capture, market conduct claim counts, and record retention. Ask whether these run from claim data as the work happens, with reporting status visible on the file, or depend on someone remembering. | Carriers and self-insureds with liability books, and the administrators who report on their behalf. |
| 09 · Bordereau Reporting | For delegated business only, but decisive when it applies. Bordereaux should populate from claims data as the work happens, not get assembled from extracts at month end. | TPAs, MGAs and coverholders working delegated authority. Drop the line if none of your business is delegated. |
The third column is a starting weight, not a verdict. Two operations of the same type can still rank the nine differently, a commercial auto administrator and a coverholder producing London reporting being the obvious pair, and that is exactly why you write your own criteria instead of inheriting a vendor's.
FOR EVERY VENDOR
Seven Questions, All of Them in Writing
Send the same seven to everyone on the list on the same day. Comparable answers are the whole point, and how readily each one comes back is itself an answer.
01 · TIMELINE
The Implementation Timeline, with Your Obligations in It
Any vendor can quote a fast go-live. The document you want names the phases, what the vendor does, and what your team must do, because implementations slip on the client side as often as the vendor side, and an honest vendor will say so.
02 · REFERENCES
References, Plus One Client Who Left
Happy references are curated. How a vendor talks about a departure tells you how they will behave in year four of your contract, and a vendor who insists nobody has ever left is telling you something too.
03 · SUPPORT
Who Supports You After Go-Live, by Name
Not the tier structure. Ask for the actual arrangement: who picks up the phone in the first weeks, how issues escalate, and whether support comes from people who understand claims or from a queue.
04 · PAYMENTS
How Payments Reconcile to the General Ledger
Follow one payment from approval on the claim to the entry in your books. Every handoff a human touches in between is a control weakness you will eventually be explaining to an auditor.
05 · PRICE
What It Costs, and What It Costs at Renewal
Get the whole number in writing: what the license covers, what is billed separately (implementation, integrations, sandbox environments, added users, new report builds), and how the price can move when the term ends. Ask for the uplift formula or a renewal ceiling as a contract term. A vendor who will not put one in writing has already told you what year three looks like.
06 · EXIT
How You Get Your Data Out
Before you sign, find out what leaving looks like: which formats your claim records, documents, and audit history come back in, how long the vendor keeps the lights on while you migrate, and what the exit costs. Put it in the contract rather than the sales conversation. How readily a vendor answers this one also tells you how confident they are that you will stay.
07 · AI
What the AI Does Inside the Claim, and Who Stays Accountable for It
You will hear about AI in nearly every demo this year, so hold it to the same standard as everything else. Ask what it touches inside the file, whether the adjuster stays in control of the output, whether each AI-produced item is attributed and reviewable in the file's own activity record, and whether you would be comfortable putting that output in front of a regulator. Fast in the wrong direction is just wrong sooner.
IF ANY OF YOUR BUSINESS IS DELEGATED
Oversight stopped accepting a signature
As of January 1, 2026, Lloyd's made Claims Management a hurdle Principle (Principle 4). The Principles bind managing agents; delegated claims administrators (DCAs) and coverholders carry it through the managing agent's oversight, audit, and reporting requirements. Delegated business outside Lloyd's is heading the same way.
It changes what you are buying. A system that can describe its controls is no longer enough if it cannot produce the evidence of them on a named file, on request, in the shape the reviewer expects.
THE ASK NOBODY MAKES UNTIL IT HURTS
Lloyd's coverholder claims reporting standards have been revised across several versions, and the Core Data Record is reshaping what London expects to receive. When a version updates, does the vendor pin versions and manage the change for you, or do you find out when a submission bounces?
Questions About Running the Evaluation
What if a vendor will not put one of these answers in writing?
Record the refusal and weight it. A vendor who will answer a question in a meeting but not in a document is telling you which answer would survive being quoted back. Every question on this page is written to be answerable in a paragraph, so a refusal is about the answer rather than about the effort.
The capability we need is on the roadmap rather than in the demo. How should we score it?
Score what you can watch running today. A roadmap item is worth exactly what the contract says it is worth, so either get the delivery date and the remedy written into the agreement, or score the capability at zero and decide whether the rest still wins.
We are a small claims operation. Is this framework too heavy for us?
Cut the criteria, not the questions. The nine capability areas are meant to be weighted and pruned against your own book, and an operation with no delegated business should drop the bordereau line outright. The five oversight questions apply at any size, because accountability does not scale down.
What belongs in our RFP that is not on this page?
Three things only you have: your own handling standards written out as the system would have to enforce them, the weighting you are giving each capability area and why, and an inventory of the systems a claim already touches, with the direction data moves between them. The guide sets the criteria, and those three make them yours.
DISCLOSURE
So where does VCA fit?
VCA Software wrote this guide and kept its name out of it until now on purpose, because a framework is only worth something if it is useful whether or not you ever talk to us. Here is the disclosure, in one place, at the end.
VCA makes claims management software. VCA ClaimsCore is a complete claims system that sits beside the policy system you already run, and add-ons are added to it for specific jobs, never sold without it.
If VCA makes your shortlist, test it hardest on the three things it says set it apart, with the questions on this page:
- Depth of Claims Expertise. Run the five oversight questions on one of your own claims, and judge whether the answers come from people who know the work.
- Speed of Implementation. Ask for the timeline in writing, with your obligations in it. Every VCA implementation starts with discovery, and the bands are published.
- Capital Efficiency. Ask for the whole number and the renewal terms. VCA puts its cost at a fraction of a core replacement, because nothing beside claims is replaced.
The Implementation Timeline, Band by Band →Where VCA Is the Wrong Choice →See the Results →
HELD TO OUR OWN SECURITY CRITERION
The Auditor, Named
VCA holds SOC 1 and SOC 2 reports, each Type 1 and Type 2, examined by Prescient Assurance. A guide that tells you to insist on a named auditor should name its own, and should point you at the page where its security posture is published rather than summarize it here.
- The framework above comes from more than 20 years of building software for claims teams.
- Claims run on VCA today at operations including TWICO, PIB and Unity Claims Management.
Bring us a claim where the promise was hard to keep
Once you know what you are judging, bring it, along with one of your own claim scenarios to run it against.
Request a Demo