Outsource Insurance Claims Administration Services
We have vast experience in providing back office support services for insurance claims administration and can leverage it to develop a holistic approach to your claims settlement process.
Insurance back office pro has over 8 years of experience in end to end insurance claims management services. We have a team of highly skilled claims adjusters, specializing in all the operational verticals of insurance claims management. We leverage their expertise and understanding to identify general, strategic and tactical opportunities for improvement and streamline your operations, minimize costs and protect the interests of the consumer.
Existing insurance claims administration models are massive and siloed enough to handle complex or high-volume operations efficiently. By harnessing the services of experienced resources, fine tuning process components, and implementing effective supporting technology, we help you to develop a more holistic approach to claims settlement and use it effectively as a market differentiator. From claims evaluation to business-critical components like fraud investigation and information verification support, we leverage our vast experience as an insurance claims administration company to assist you in developing a holist approach to claim settlement.
Our Comprehensive Insurance Claims Management Services
Our insurance claims process service includes investigating claims and the report on the resolution/denial of claims. It extensively involves interpreting and applying relevant policy provisions for regulatory compliance and fraud prevention. Our professionals have vast experience in determining coverages, eligibility of the claimant or beneficiary; verifying the value of the covered claims; determining that the service was necessary; and ensuring that the benefit is not covered under another policy. We leverage our in-depth understanding of the language of policy to report on the ultimate coverage position on behalf of the insurance company.
Our insurance claims process involves handling bulk of the paperwork involved in an insurance claims evaluation thus freeing insurance companies to concentrate on their core activities. Our tried and tested procedures ensure fast and accurate claims report evaluation.
Policy Information Verification
Verification plays an important role in claims denial management program. We provide the back-office support needed to verify a patient’s active coverage with a carrier along with their eligibility. We also check an insurance policy to verify the information provided by them. This can be particularly helpful, when patients fail to update information, which can lead to denials sand consequent legal hassle. As a reputed insurance claims administration company, we have a well -established verification process that verifies a wide range of data from the type of plan table benefits deductibles effective date and coverage details to arrive at right conclusions. Our dedicated verification services has helped many carriers and agents reduce their effort and time on this important task; build customer relationship by speeding up approval, simplify workflow, improve staff productivity and reduce operational costs.
Verify Coverage and Liability Amounts
We help insurance companies discharge the responsibility of identifying their patients and providing a way for medical/auto offices to verify patient insurance coverage. Our task first begins by enquiring a few things in order to verify that the call is received from a real provider's office. Thereafter, we verify plan benefits with regard to in-network coverage and out-of-network coverage on behalf of the carrier.
Our service also entails providing additional information on deductibles, coinsurance responsibilities, and applicable co-pays. If the provider is a PPO-provider only, we provide information on the patient’s PPO benefits too. Our verification assistance service is provided both over mail and phone. We designate specific teams to handle the verification process. This guarantees speed and accuracy. We also have a proper security model in place to ensure there is no-compromise on data security.
Assistance with Accord Forms
We have a complete understanding of Accord forms and the important role it plays in an agency’s everyday business. We have leveraged this understanding to help agencies and carriers overcome the tedious nature of the job with great finesse. Today, we bank on an automated solution to fill up these forms and save time and money for our clients. Our software solution supports a huge list of accord forms, and maps policy information directly to the right form. This removes manual intervention completely and can help you improve your process efficiency significantly.
Some crucial and commonly used forms our solution supports include Form 25 (Certificate of Liability Insurance) Form 27 (Evidence of Property Insurance) Form 80 (Homeowner Application) Form 90 ( Personal Auto Application) Form 125 (Commercial Insurance Application) Form 126 (Commercial General Liability Section) Form 127 (Business Auto Section) etc.
We help carriers and agencies manage fraud investigation by scrutinizing claim forms and scouting for discrepancies. We leverage advanced technologies like data analysis and machine learning to make it easy to flag potential fraudulent claims. We also organize, manage and monitor crucial fraud investigation activities like background check of the claimant, creditworthiness, personal details and more. We arrange for and co-ordinate with specialized professionals like private investigators to enable faster access to accurate information.
How Our Insurance Claims Administration Service Gives Your Business an Edge
We follow some best practices to guarantee high equality insurance claims processing. Most of these proven process elements are stored in a common repository of procedures and are reused for ensuring optimal processing of claims. This can bring about huge time savings, less loss adjustment expense and zero claims leakage.
We work towards developing a model that can manage the complex elements of work across operational silos and at the same time provide end-to-end visibility. For instance, complex insurance claim processing services are broken down into smaller units, each of which is managed individually. Real-time analytics help unit managers to get an overview of the operations anytime. Based on their understanding, they can re-assign work as and when needed, thereby enabling a dynamic response to changing needs or shifting work volume. This way you get a clear picture of what is working well and what isn’t. Work that is of little value, but a mandatory requirement to the organization are automated to bring in productivity gains.
Our insurance claims processing services provide our clients with a dedicated claims coordinator to monitor the performance of the insurance claims process at all stages and across silos. This ensures seamless reporting as well as guaranteed protection of the interests of the client under the policy contracts.
It is because of all these reasons that our clients outsource insurance claims administration to us.