Claim Review

At NextClaim, we have the most experienced and dedicated staff in the industry.  Our analysts are experts at extracting pertinent information from raw documents – including complex and sensitive medical reports, legal documents, and settlement-specific supplementary documents. Our staff’s expertise extends to so much more than mere information extraction.  They are able to intelligently and systematically filter that information through complex rule sets to draw accurate and useful conclusions—leading to more effective and efficient claim resolutions.

We have crafted a unique approach to claim review that is informed by our decades of experience.  This approach involves standardized, documented, and monitored processes designed to maintain exceptional review quality, as we work in high transaction volumes.  Our reviewers adhere to a set of best practices that ensure each claim is approached in exactly the same manner, resulting in consistent and predictable outcomes.

We categorize tasks by complexity and route them only to the individuals best-suited for the job.  By minimizing how many individuals touch each claim, we also reduce the potential for error and delay.  Further, utilizing and optimizing such specialized teams and automation allows our reviewers to focus their energy on reviewing actionable claims.  

Automation

We automate tasks wherever possible, so that we preserve our most valuable resource – our claim reviewers – for actionable claims.

We excel at identifying how and where to enhance our processes with technology, and we have integrated automation into all aspects of our review process. For example, we build logic into our systems to identify anomalous fact patterns and to ensure reviewers apply our processing guidelines consistently and accurately. We utilize automatic system checks to confirm whether all of a claim’s critical information has been reviewed and given the individualized attention it deserves.

Our sophisticated technology is one of our strengths, but so is our understanding that many tasks require the detailed attention and human judgment of one of our reviewers.  We focus on automation to ensure our reviewers’ attention and energy is where it should be: on finalizing the most complete, actionable claims.

Deficiency Response Unit

Not all claims are submitted in satisfactory fashion. When this happens, deficiencies are applied to identify the critical errors that will prevent a claim from moving forward. The Deficiency Response Unit screens newly submitted information and documentation to ensure that the submission properly addresses the deficiency communicated to the claimant. This is a critical piece of ensuring efficiency in the overall review process.

General Review Teams

The backbone of NextClaim’s strategy is the Review Teams. These teams are organized into highly efficient, modular units, supported by a dedicated manager who shares the same workspace. This hands-on approach facilitates on the spot mentorship, support, and supervision. Our review teams are cross-trained to process claims for multiple settlements at a time, which turns them into a dynamic and flexible workforce that can scale at the drop of a hat.

Specialized Review Teams

NextClaim understands that no two claims are alike.  Some claims are more challenging and complex, requiring more attention. We route these more complex claims to our specially-trained Complex Review Teams.  This way, we ensure each claim receives the appropriate care, while avoiding interruptions to our overall claims process.

Having a dynamic, highly educated, and experienced staff allows us to utilize our teams’ backgrounds to the greatest benefit of our claimants.  We have several teams that provide specialized review.  Staffed by nurses and legal professionals for example, these teams are able to draw upon their specialized skills and experiences when processing claims –yet another strength that elevates the NextClaim experience above the rest.