Our Services

Outsourced MSL Claims Administration

Operational Assessments

Claims Audits & Reserve Analysis

Outsourced MSL Claims Administration

We specialize in high quality, expedited back-office claims management. We can be full time claims staff or a safety net for peak season. Our comprehensive claims management includes: 

  • Claims Intake 

  • Notice Tracking and Notification 

  • Document Management 

  • Payment Recommendation 

  • Reinsurance Reporting & Tracking 

  • Customized Reporting to suit your business 

  • Participation in Implementation Calls as needed 

With our comprehensive claim services, you can count on responsive, accurate and timely administration. We achieve this by applying the appropriate contractual provisions; plan specifications of the underlying plan document; case management resources; and claims practices, procedures, and protocols to the medical facts of each claim to decide on reimbursement or denial of a claim.  

Managing claims workloads: claims departments should have no more than a 10-day turnaround on claims. This is a standard to which AIS operates. If you find that your claims backlog is running longer than 10 days, AIS can assist in getting your claims back under control. Don’t wait until carrier audits and questions being raised about your claims function, or worse have claims backlogs become a service issue for your MGU with your producers and insureds. AIS can handle the overflow and keep you within industry standards. Whatever it is, the way you tell your story online can make all the difference.

Operational Assessments

With years of experience in running medical stop loss claims departments, AIS is ideally positioned to consult on the operations of a MGU or insurance carrier’s claims department. If you are looking to set-up a claims department, AIS will help you through the process providing procedures manuals and guidance on the resourcing of your claims department, both staffing and technology needs.

If you are looking to bring claims administration services in-house, AIS can assist in the transition and oversight of your claims team to ensure that your claims process runs smoothly. Our services can also be structured for AIS to manage your claims department. This can be a cost-effective way of handling your claims function but retaining the best-in-class services of a specialist stop loss claims administrator.

Not sure your claims department is running as well as it should? AIS can provide a periodic operational assessment or check-up to identify areas for improvement.

Claims Audits & Reserve Analysis

In the employer stop loss market, several different parties have an interest in knowing whether claims are reserved and paid correctly. An insurance carrier granting claims authority to an MGU will have a right to audit the MGU’s claims handling practices, but equally an employer or a captive which is responsible for payment within a specific and/or aggregate layer will want assurance that claims are being managed appropriately and payment are correct. AIS and its specialist claims administrators have many years of experience managing stop loss claims including audits of claims departments. These audits include:

  • Large individual claims

  • Periodic audits of claims departments

  • Review and audit of aggregate claims

  • Review of claims handling procedures and operational practices