Claims Management

  • The transition to Cook Group platform will be immediate since we will lead the plan design structure.
  • Administration of the healthcare claims provisions as outlined in the plan sponsor’s benefit booklet, including ongoing updates or changes.
  • Conduct necessary claims inquiries appropriate to benefit plan provisions; coordination of benefits, pre-existing conditions limitation, reasonable and customary expense levels, and an auditing program to review claims, which appear to be excessive.
  • Assist the client in establishing internal claims procedures and in the drafting of claims/benefit notices to eligible participants.
  • Client notifications of developments in the employee benefit field, which may impact the client.
  • Comply with the new DOL regulations regarding appeals and their speedy and impartial resolution.
  • Provide all required reports.