The claim payment function is the means by which you fulfill your contractual promises to provide financial protection in the event an insured employer incurs a covered loss. The claim payment function at IR&AS is driven by the accomplishment of three main objectives.
Our primary objective is to pay all valid and appropriate claims, fairly, promptly, and efficiently, in accordance with the terms of the policy. Our second goal is to prevent, control and reduce the impact of catastrophic losses by maximizing case management capabilities and introducing proactive treatment options. Our third, yet just as crucial, objective is to accumulate and make available claim data for accounting, statistical, and analytic purposes.
Claims Administration services include:
- Programming of excess loss policy parameters and limitations into a computerized claim system.
- Review of claim payment requests for accuracy, compliance with policy terms, and adherence to plan documents.
- Review of potentially catastrophic/medically-complex claims for medical management strategies, care coordination, network access, and to make available our claim management and loss control resources.
- Investigation of potential Subrogation Recoveries.
- Generation of an Explanation of Benefits.
- Distribution of claim payments.
- Establishment of claim reserves.
- Toll-free phone line to handle inquiries pertaining to claims received from policyholders or agents.
- Development of necessary claim experience, and other management reports, in a format agreeable to you.