Outsource to Optimize: Medical Stop Loss Claims

by | Jun 15, 2024

Many managing general underwriters (MGUs), insurance carriers, captives, and self-insured organizations are faced with an increasingly challenging task of processing and administering Medical Stop Loss (MSL) claims. Outsourcing MSL claims administration allows organizations to maximize operational efficiency and cost-effectiveness while maintaining quality control.


The administrative burden of MSL claims processing, including audits, data analysis, and compliance requirements, can prove costly for many organizations. These costs can escalate rapidly when internal departments lack the specialized skills and systems to handle the job effectively. Outsourcing MSL claims administration to a specialized service provider introduces a degree of cost control that’s often hard to achieve in-house. There are additional/related long-term savings in outsourcing claims administration through reduced overhead costs: the wages, benefits, equipment, space and power that managing your own team would cost.

AIS’s flexible pricing structures – whether time and expense, per claim, or fixed fee – enable organizations to better predict and manage costs, turning variable in-house costs into predictable outsourced costs.

AIS brings a depth of specialist expertise to manage complex and fluctuating claims workloads, providing an invaluable safety net during peak seasons.

Resource Allocation

Outsourcing to a specialist claims administrator can significantly enhance resource allocation. By freeing up staff from labor-intensive tasks like claims intake, document management, and reinsurance reporting, organizations can refocus their personnel on their core competencies. For MGUs, for example, this means dedicating more resources to underwriting and strategic business growth.

Operational Efficiency

The efficiency of MSL claims administration directly impacts an organization’s bottom line. AIS brings industry-leading standards to the table, including a 10-day claims turnaround guarantee, which sets a new benchmark for operational efficiency. This high level of performance is achieved by leveraging specialist knowledge, proven processes, and advanced technology.

Quality Control

Outsourcing MSL claims administration to AIS ensures an unparalleled level of quality control. AIS uses data validation and analytic tools to mitigate the risk of errors and oversights in claims processing. Further, AIS provides operational assessments, periodic check-ups, and audits to ensure that every process aligns with industry standards, maintaining a high level of quality assurance.