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Appeals

Short Term Disability, Long Term Disability, Life Waiver of Premium…we have the experts.

Focus

For years, SALT has been helping carriers and reinsurers address risks associated with claim management and claim operations.  We’ve established a successful record of identifying specific areas of high risk, sourcing that area with expertise and deploying the resource to our  clients.  Appeals are yet another area of our focus where we can provide independent expertise to fill very important voids in staffing or outsourcing.

 Importance of Appeals Expertise – What we’ve seen

-          Misunderstanding  of ERISA timeframes

-          Use of same claim team to address appeals

-          Inaccurate or incomplete denial/decisions letters

-          Decisions based on undocumented information

-          Denial or decision letters not in accordance with ERISA

-          No de novo review

-          Not using appeals for training and development

 

Our Appeals Service Includes

  • Thorough de novo review of adverse claim decisions
  • Ensures appeal process remains independent of claim organization
  • Compliance with ERISA timeframes
  • Identify training and development opportunities
  • Identify risk management trends
  • Provide feedback to claim organization
  • Conduct full and fair review for claimant to exhaust their administrative remedies
  • Conduct full and fair review for carrier to ensure appropriate decisions are made
  • Educate claimant/customer – ERISA, appeal procedures and next steps if any

 

Results

Financial returns vary by customer.   However, our claim appeal experience, strict adherence to the laws and guidelines, and customer service focus ensures that your claims are handled professionally. Why take the risk?  Consider our Appeals services.