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Third Party Administration | Claims
Services | Client Services | Disability
Management |
Third
Party Administration
Administering
a group insurance benefit program involves managing detailed,
vital, personal information and employers are being legislated
to more complex administration standards. Most employers simply
do not have the people resources to effectively and efficiently
manage this major component of employees' compensation.
At groupSource, we recognize that to
survive and thrive, businesses require clear opportunities to
focus on their core business activities. Effective and efficient
plan administration is our core business. Currently, groupSource
handles over 1,100 employee benefit plans encompassing more than
22,000 employees and their families.
Efficient plan administration provides:
- Knowledgeable, experienced and committed benefit administrators
that update and maintain all employee records on an ongoing
basis
- Direct access to and personalized service from designated
benefit administrators
- Information and well-timed notices pertaining to beneficiary
records, salary levels and employee coverage status
- Precise and detailed monthly billing statements
Effective plan administration provides:
- Employee satisfaction with a meaningful
benefit program
-
A reduction in costs associated with offering
and maintaining a forward-looking benefit plan
- Employers and employees with the ability
to focus on core business activities
- Reduced potential employer liability
associated with administrative errors or omissions
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Claims
Services
Claims adjudication
is the application of group policy guidelines and provisions to
pay claims efficiently and effectively. It involves personal medical
information which requires privacy and confidentiality protection.
At groupSource , a core business activity since 1989 has
been the verification and application of policy guidelines and
provisions to process health and dental claims efficiently and
effectively on our proprietary claim payment system.
Efficient claims services provide:
- Knowledgeable adjudicators that process claims and answer
inquiries about specific claims issues
- Experienced claims adjudicators that research discrepancies
and contact providers to obtain missing information
- Adjudication to the highest standards without prejudice
- Regular internal and external claims audits to ensure quality
and consistency
Effective claims services provide:
- Standard claim turnaround time of 48
hours upon receipt of claim
- Payment with an Explanation of Benefits
indicating eligible and ineligible items
- Security of personal claim information
- Processes that conform to Canada Customs
and Revenue Agency to protect the tax-exempt status of benefits
paid from private health plans
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Client
Services
At groupSource, a core business value
is client centered service. Our client services team works closely
with employers and their employees, our insurance partners, brokers
and co-workers to provide reliable, unbiased information relevant
to specific concerns and questions.
Each client has an assigned Coordinator of Client
Services; a knowledgeable and experienced person who provides
expertise in efficient and effective benefit plan management.
Efficient client services provides:
- Personal, on-site training meetings with plan administrators
- On-site employee meetings outlining and clarifying benefit
plan coverage
- Coordination of information and documentation
for plan design amendments
- Normal response to telephone inquiries within 24 hours
Effective client service provides:
- "Front-line" resource services
including assistance in the interpretation of contractual and
administrative provisions
- A firm understanding of provincial
employment regulations and standards
- Monitoring sensitive claims, such
as Life, Accidental Death & Dismemberment
- Clear, courteous and complete information
regarding complex claim issues
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Disability
Management
At groupSource,
a core business philosophy is disability case management that
focuses on early involvement with the absent employee, in a caring,
compassionate manner. The goal is to assist the employee to return
to work in a safe manner as rapidly as is appropriate. Efficient
and effective disability case management services are best achieved
through the cooperative efforts of all stakeholders including
the employee, the employer, the insurer, and disability case managers.
groupSource offers adjudication and case
management services for Short Term Disability and Medical Absence
benefits as well as facilitation services for Long Term Disability
benefits.
Efficient disability services provide:
- Manageable caseloads per Disability Case Manager
- Intense case management planning as early as possible during
the disability absence
- Expert claim adjudication including
comprehensive telephone interviews with the employee and employer
- Advance reporting of longer duration claims for assessment
of eligibility for Long Term Disability benefits. A separate
claim application is not required
Effective disability services provide:
- Team approach with our clients and
insurance partners for claim resolution
- Clear, courteous communication with
absent employee to support full understanding of claim direction
and decision
- Formalized claim referral process
- Return to work intervention and facilitation
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