Long-Term Care Insurance Administration

We have a culture focused on our customers. We provide diverse services for policyholders, such as mail room and imaging, underwriting and new business, policy administration, handling of premium billing and collections, commission processing and payments, a significant knowledge base, and automation tools. We aim to make your operations more efficient, saving you time and making your life easier.

We bring a wealth of experience and expert resources to risk management. We recognize that objectivity, accuracy, timeliness, and professionalism are paramount. We communicate clearly and frequently with all stakeholders and provide our clients with the digital tools required to participate actively in the appeal process. Because we strive for decision and financial accuracy, training our people and quality assurance are integral to how we operate. Finally, our platform provides broad automation of calculations, caseload, task management, and accurate payments with multiple controls in place.

Our claims managers have a wealth of resources at their disposal, including functional, cognitive, and medical profiles, multi-focal assessments, Plan of Care (POC) guidelines, a claim review committee, established benchmarks for recovery and POC management, a medical director, actuarial resources, and SIU. We follow a “hub and spoke” model that integrates best-of-breed vendors for managing claims, including assessments, aging-in-place initiatives, wellness, and EVV. Throughout this process, we maintain a strong focus on the customer experience, with support from our Policyholder Portal.

Our single-platform proprietary technology and project management experience ensure a smooth transition and exceptional customer service for you and your policyholders. Our collaborative onboarding approach helps us better understand your risk tolerance and create custom claim guidelines.

Our robust suite of actuarial services are tailored to meet specific needs, from actuarial support for existing businesses to assessing the viability of a new product offering. We can deliver on time-sensitive initiatives and more extensive block analyses—or anything in between. These services include end-to-end rate increase implementation, gross premium valuation and reserve adequacy monitoring, financial projection, financial reporting (management reports, statutory and tax reserves), experience studies, due diligence, and audit support.

Our auditing team also plays a vital role in the client experience. We conduct periodic systematic reviews of all claim segments and ensure compliance with regulations and client requirements. These auditing professionals also make recommendations to enhance the handling of specific claims and identify potential training needs. They are always open to discussing process evaluation and feedback.

Our long-term care claims professionals are well-versed in handling rate increases and utilize our proprietary rate increase engine key for fast and high-quality delivery. We have implemented all approaches, including landing spots and cash offers. We have the proven ability to administer an “in-flight” rate increase during the conversion of a block to our platform. Our process typically implements rate increases within two weeks of receiving state approval.

Our experienced team handles fraud, Special Investigations Unit (SIU), and consumer complaint reporting. We also monitor changes in claims adjudication regulations and privacy requirements and evaluate the impact of regulatory changes and proposed regulatory changes. Additionally, we assist with new product filings supported by our experience with the interstate compact, annual state filings, and meeting OFAC compliance requirements.