Claims Advantage

Claims Advantage, powered by e-Triage®, is a proprietary web-based application that addresses core problems such as inconsistency in claim practices and failure to identify complex files early in the life of a claim. By using a multi-tiered interview process backed by scientific evidence-based research, Claims Advantage functions as an effective decision support system that helps our claim professionals identify potential complications and recommend actions for optimal management.

Strategic Plan of Action

After analyzing issues and recommendations, claim professionals work with senior nurse reviewers, subject matter experts and supervisors as needed to develop a strategic plan of action. Clear, concise plans can shorten claim duration and lead to better medical care and lower costs. Our strategic plans set a goal and identify the steps required to effectively achieve the stated goal. They include:

• Goal setting
• Timelines
• Medical management objectives
• Litigation strategy
• Tactics
• Reserve rationale

For liability claims, we have adjusted our strategic plans of action to fit their unique requirements and have created an automatic template that prompts claim specialists to consider all implications of such claims.

Senior Nurse Reviewers

Senior nurse reviewers work in tandem with claim professionals, nurse case managers, injured employees and clients to facilitate successful return to employment and claim resolution. They lend their medical expertise whenever necessary to ensure that each claim is optimally managed. In addition, they provide:

• Medical analysis of Claims Advantage interviews
• Medical diagnosis, treatment plans and medication research
• Strategic plan of action consultation
• Ongoing communication regarding medical issues

Contact us to learn more about how Claims Advantage can improve your workers’ compensation and liability program.