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Claim Reporting and Recovery

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  • Claim Reporting and Recovery

A software solution to manage the communication, reporting, and recovery of specific stop-loss claim submissions. Track claims, receivables, pending claims and denials, and recoveries with carriers and managing general underwriters.

 

 

FILING AND REPORTING

File Specific notifications and claims with carriers and managing general underwriters

  • Submit Specific 50% and trigger diagnosis notifications, claims, and appeals directly to the carrier or MGU securely without the hassle of maintaining an FTP site or third party secure E-Mail.
  • Import and submit line-by-line claim details.
  • Attach and submit documentation for eligibility, pre-certification, case management, subrogation, COBRA, etc. to completely document the claim.
  • Track aged claim receivables by policyholder, claimant and carrier.
  • Record claim recoveries by date received and all charges pended or denied by the carrier.
  • File appeals for pended and denied charges and track all outstanding pended or denied charges by policyholder, claimant and carrier until complete.

ANALYSIS

Track a summary of year-to-date claim charges and a history of all claimants with all notifications, claims, appeals, payments, denied and pended charges, including diagnosis, eligibility and outstanding receivables.

CLAIM RECOVERIES

Manage all claim submissions to their final recovery by policyholder, claimant and carrier:

  • Track aged claim receivables by policyholder, claimant, and carrier.
  • Enter claim payments along with pended and denied charges for later appeal.
  • Report recoveries to policyholders.

RENEWAL MARKETING

Assist underwriters with up-to-date information on ongoing claimants at renewal:

  • Provide shock loss claim summary by policyholder.
  • Provide claim details on select claimants along with diagnosis summaries ordered by diagnosis with highest dollars spent to lowest.

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Schedule a Demo

Our clients choose Connexure because our solutions are integrated, efficient and secure. We run on cloud-based software and secure our data through SOC II audits, penetration testing, and MFA. 

Set up a demo today. We’ll deliver a comprehensive overview and show you why we are the leading option for stop loss medical insurance software in the country.

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