Our Clients
Managing General Underwriters (MGUs)
Insurance Carriers
Retail Brokers & Reinsurance Intermediaries
Captives & Self-Insureds
MGUs
AIS provides specialist claims administration support to MGUs. This can range from providing a best-in-class back office operation to operational assessments or support during peak times. In all of these situations our MGU partners are assured of specialist and dedicated claims handling expertise from a leading provider in the field.
Why outsource claims? This is a question we are often asked but it is one we turn around to why wouldn’t you outsource claims? The management of claims requires a unique skillset and policies, procedures and standards focused on managing claims. For a MGU this means building a second core competency beyond underwriting expertise. Using a specialist claims administrator such as AIS allows a MGU to focus on its core underwriting competency and compete in the knowledge that claims will be handled in accordance with industry standards.
Our services to MGUs include:
Full outsourced claims administration services: we will design your policies and procedures and manage your claims to our industry leading standards, including our 10 day claims guarantee. Our pricing structures are flexible from time and expense, per claim or a fixed fee structures. We will also manage a dedicated claims department for a MGU providing a cost effective structure with a specialist claims administrator and support for handling fluctuations in workloads.
Operational assessments: we use our expertise in managing claims departments to set-up claims functions for MGUs, developing policies and procedures and conducting periodic reviews to ensure that your claims department is operating efficiently and meeting industry standards.
Over-flow and individual claims management: AIS can provide additional resources to your claims department. This can be for individual claims, aggregate or specific, to manage peak loads or clear a backlog or to provide temporary resources.
Insurance Carriers
AIS can bring its industry leading claims standards to support both direct writing insurance carriers and those writing through MGUs.
Direct Writing Carriers: Our services support carrier claims departments in a similar way to our MGU partners. You’ll receive:
Full claims administration services for specific programs or expansion into new sectors of the stop loss market
Peak load or backlog claims handling
Through our audit process, your claims will be mitigated.
MGU Carriers: Carriers partner with us to audit MGUs ensuring that employer stop loss claims are handled appropriately and claims payments are accurate. We manage both desk audits and site audits and use data validation and analytic tools to identify anomalies and focus our claim audits.
Retail Brokers & Reinsurance Intermediaries
AIS can provide retail and reinsurance brokers with a stop loss claims resource to monitor and evaluate claims on behalf of their clients. We review contractual arrangements and plan documents to determine coverage and use medical and case management expertise to manage the cost of the claims. Our medical review services can provide support on reserving and the handling of large claims in renewals and the need for or management of lasers.
Captives & Self-Insureds
Employers who self-fund medical expenses are looking to take control of their health insurance costs. However, claims payers or TPAs do not have the financial incentive to control claims costs. Auditing the performance of the TPA often leads to cost savings for the employer. AIS can provide TPA audit services across all claims or selectively on large individual claims or aggregate claims.
Captives: recent developments in the medical stop loss market have seen the use of captives to reinsure a layer of the stop loss program above the employers’ self-funded layer. These structures are being used by both larger employers in single parent captives and groups of employers in a group captive structure. The captive acts as the reinsurer and is financially responsible for claims in the layer of risk it reinsures, although claims are managed by the stop loss carrier or MGU. AIS can monitor and evaluate claims in the captive layer to ensure that the captive’s claims payments and reserves are appropriate under the employer stop loss policies and reinsurance treaty.