Each claim presents a unique set of facts and circumstances which merit thorough investigation and objective evaluation. Proactive and expert management is necessary to ensure that each claim is accurately and efficiently adjudicated.
Each claimant deserves to be treated with dignity and respect, and is entitled to a fair and timely benefit determination.
Claim Management Approach
- Leverage well trained, experienced and highly skilled claim professionals who can think critically and work proactively.
- Utilize an activity based claim objectification approach stressing early and direct involvement by qualified professionals.
- Integrate specialized clinical and disability claim management resources to ensure comprehensive benefit eligibility assessment.
- Enable claim experts through the deployment of proprietary technology that enhances communication and operating efficiency.
Keys to Success
- Knowledgeable and experienced claim professionals
- Strong commitment to training and compliance
- Utilization of an activity based claim objectification approach to benefit eligibility assessment and claims management
- Early and direct vocational intervention with return-to-work focus
- Occupational analysis
- Transferable skills analysis
- Ergonomic assistance
- Vocational counseling and transitional services
- Effective integration of specialized clinical and claims management resources, ensuring comprehensive benefit eligibility assessment
- Strong emphasis placed on expert analysis – understanding of policy language/provisions and their application to benefit eligibility
- Propriety technology enhances communications and operating efficiency
DMS Internal Resources
- Disability Claim Specialists
- Appeals Specialists
- Social Workers
- Masters Level Therapists
- Clinical and Forensic Psychologists
- Database Researchers
- Vocational Rehabilitation Professionals
- Financial Specialists
- Medical Evaluation
- Specialized Vocational Resources
- Social Security Advocacy
- External Legal
Legal, Audit & Compliance Support
- Highly experienced attorneys on staff
- Minimize incidence of litigation by applying dispute resolution techniques
- Proactive management of litigation to promote fair and cost effective outcomes
DMS Audit Team
- Regular review of claim files and additional targeted reviews as necessary
- Ensure compliance with regulations and client requirements
- Recommendations for further claim evaluation
- Identify training needs and gather process improvement feedback
- Fraud/SIU reporting
- Consumer complaint reporting
- Monitor changes in claims adjudication regulations
- Monitor changes in privacy requirements