Global Vision #44

The claim adjudication module has been developed with in mind a working desktop where each operator, processing claims, will be able to find the overall adequate information on environment. Thus, the system will allow access to the various modules to manage batches of sickness related accidents or any other claims that need to be process.

Using a specialized and flexible desktop environment the administrative manager will be able to process claims respecting is own work methodology. He will easily access any claimant insured file by selecting from a complete list of insured. Whether the claimant is a dependant, a spouse or the employee, Allegroup will automatically identify the proper claimant and link him to the insured. Once the claimant file has been identified, the desktop will automatically display the list of any pending claims.

It will be easy for the operator to locate an individual or a family member just by using the appropriate searching modules. In addition, it will be possible to find a pending batch or finalized one by the number that assigned automatically by the claims’ adjudication system.

A highly sophisticated managing module will give access to various specialized options in order to manage the overall assigned information or to be processed as claims.

Accessing the management and statistical option will give the operator access to several new appropriate sub-options allowing him to manage all his activities. One will note many complementary services enabling the production of various statistical reports, such as the report 22 statement.

The desktop made available to the claim manager will insure access to all the necessary information to maintain full operative claim management.

Managing accumulators is an essential activity to properly manage claims.

Through business rules, the administrator will then be able to determine the limits being imposed on each accumulator. Thus, allowing him to determine individual, parental, or family units’ limits. Following this, from the adjudicated various claims, it will be possible for the manager to consult each activity related amount.

The dental management module will allow to individually manage each tooth from each individual.

Thus, allowing ground for a thorough control of each member’s claim.

The administrator will be able to manage health accounts through a fully integrated administration and claims management module.

Based on the authority level, manager will gather information through the titled insured’s health bank.

Or, he could change the health bank amount available for each individual.

To make it easier for the manager, it will be possible to access a full listing of all insured.

The claim managing tools allow for processing short and medium term disabilities. So, with Allegroupe, payment listing will be possible along with appropriate follow-up of each disbursement.

The preference module manager allows for specific defining user management based on how you expect the Allegroupe module to process various operations based on the specific of each individual user.

A health option will allow the user to obtain online electronic guide.