groupSource Services

By: Groupsource  09-12-2011
Keywords: disability, Benefit Program

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

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

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

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

Keywords: Benefit Program, disability

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