Claims management

The philosophy behind our industry-leading claims protocol is straightforward: the more efficient the delivery of high-quality healthcare, the better the results for everyone.

Decades of clinical experience prove that the biggest driver of positive outcomes is the timely delivery of appropriate treatment. Eliminating delays in reporting claims and providing care leads to overall better recovery.

Expediting a return to work lowers indemnity payments, reduces productivity losses and improves employee morale.

Results

11%   decrease in ultimate claims losses

20%   increase in claims closed in less than 3 months

20%   decrease in paid losses at 18 months

37%   decrease in days to close claims

59%   decrease in time to return to work

50%   lower than average case load per adjuster

Our experienced claims team collaborates with you to deliver cost savings of 20% or more.

Claims management

When claims do occur, our seasoned adjusters deliver highly personal customer service, proactively coordinating with employers, employees and providers.

We manage every aspect of a claim to deliver the most timely, quality care, encouraging short durations and a healthy medical only / indemnity mix.

Return to work

We combine our care provider background with deep workplace injury experience to help employers implement successful return to work programs that significantly reduce lost workdays. By lowering claim durations and minimizing costly litigation, we can not only lower claims cost, but impact the hidden costs of lost productivity.

Safety & Prevention

Our certified safety and loss prevention experts conduct an initial safety survey and then we partner with you to implement individually tailored, minimally disruptive programs before accidents happen. We consult regularly with the goal of lowering your frequency and severity.

Timely.
Efficient.
Effective.

Remote triage

Immediate visual FROI and real-time, face-to-face video nurse triage provides a single, 24/7/365 point of contact for injured workers, encouraging full disclosure and helping prevent minor injuries from becoming costly claims.

Provider network

We leverage our unique provider experience to maintain the industry’s largest directly contracted, workerplace injury network. This nationwide (state-certified), outcomes-based network ensures that quality, affordable care is as close and convenient as possible.

Pharmacy network

With nearly 70,000 locations plus mail order, we provide workers’ immediate (first-fill), 24/7 access with no-out-of pocket expenses for them and no financial risk to you.

Utilization review

Because we prioritize the timely delivery of care in order to deliver results, it’s vital that we maintain 99% on-time delivery rates while still providing defensible, evidence-based guidelines that meet state and URAC standards.

Medical Bill Review

Decades of human expertise combined with one of the industry’s most advanced rules engines, allows us to negotiate an average savings of 60% from billed charges with an appeal rate less than 5%. And even though Senior Auditors review every bill, our average turn-around time is less than 2-3 days.