montage for utilization review, showing people projecting numbers and trends

Utilization Review.

While renewal negotiations occur once a year, our team works year round reviewing emerging claims utilization to identify cost drivers and target program modifications. We access several internal and industry sources to track national and local trends and obtain comparative data on benefit designs, cost and utilization patterns.

 

Our staff excels at financial modeling, using historical claims and enrollment experience to project future costs. Our specialization in employee benefits has helped our clients project costs for advance budgeting and consideration of possible alternative funding options with a high degree of accuracy. Working daily in the field with the carrier’s underwriters, we know the trend factors, can accurately estimate rate differentials for benefit changes, and calculate client specific completion factors.

 

  • Conduct a complete review of existing employee benefit plans including benefit levels, claims experience, funding arrangements and contractual obligations
  • Analyze group specific trends by comparing the most recent claims experience with past history and reviewing the claims details to help determine future cost estimates
  • Benefits Optimization – review plan design for cost containment measures that will positively impact future claims experience and develop a long term benefit strategy
  • Ongoing monitoring of health, dental, prescription drug, vision, and other insurance industry changes that might impact your current programs