HM’s claim department will work as your liaison to assure that the provider(s) are managing your claims appropriately. Most importantly, we will work with you to develop special account instructions for the provider(s) to follow which will include their commitment to claim reviews, reserve and settlement authority levels, reporting requirements, system access, and other issues of significance to your company.
In conjunction with your direction and needs, dollar thresholds will be set and agreed to by the provider(s). Our claims department will develop protocols to follow the handling of claims exceeding those thresholds and keep you informed of significant developments. Settlement authority levels will be agreed to and provider(s) will be required to notify both you and HM when claim facts develop which indicate that such levels may be surpassed.
The team member assigned to your account will proactively review claims above specified dollar levels and those that are of special interest to you on an on-going basis. Along with the claim provider(s), we will keep you informed of significant developments and issues. By doing so, we focus our efforts on avoiding any surprises as a claim progresses. An eye will be kept on reserving practices of the provider(s) and as claims are consistently reviewed, reserves will be examined.
HM will coordinate formal claim reviews with the provider(s) at a frequency agreed to by you. We will require that the provider(s) prepare written status reports on qualifying claims and discuss their status with representatives of each of our companies. By doing so, we can assure that the provider(s) has adequately handled and reserved the claim.
We are available to offer guidance on the administration of self-insured claims. We will discuss specific claim issues of concern to you and provide recommendations on plans of action. Our breadth of experience and variety of clients provides us the opportunity to present various approaches to claim resolution.
The combined experience of the HM claim service team covers all facets of the claim handling process. We have participated in claims from the perspective of a client, a carrier, a third-party administrator, and a broker. This well-rounded knowledge provides us the insight to proactively oversee your claim management process and provide advocacy on your behalf.