Automation

We automate tasks wherever possible, so that we preserve our most valuable resource – our claim reviewers – for actionable claims.

We excel at identifying how and where to enhance our processes with technology, and we have integrated automation into all aspects of our review process. For example, we build logic into our systems to identify anomalous fact patterns and to ensure reviewers apply our processing guidelines consistently and accurately. We utilize automatic system checks to confirm whether all of a claim’s critical information has been reviewed and given the individualized attention it deserves.

Our sophisticated technology is one of our strengths, but so is our understanding that many tasks require the detailed attention and human judgment of one of our reviewers.  We focus on automation to ensure our reviewers’ attention and energy is where it should be: on finalizing the most complete, actionable claims.

Deficiency Response Unit

Not all claims are submitted in satisfactory fashion. When this happens, deficiencies are applied to identify the critical errors that will prevent a claim from moving forward. The Deficiency Response Unit screens newly submitted information and documentation to ensure that the submission properly addresses the deficiency communicated to the claimant. This is a critical piece of ensuring efficiency in the overall review process.

General Review Teams

The backbone of NextClaim’s strategy is the Review Teams. These teams are organized into highly efficient, modular units, supported by a dedicated manager who shares the same workspace. This hands-on approach facilitates on the spot mentorship, support, and supervision. Our review teams are cross-trained to process claims for multiple settlements at a time, which turns them into a dynamic and flexible workforce that can scale at the drop of a hat.

Specialized Review Teams

NextClaim understands that no two claims are alike.  Some claims are more challenging and complex, requiring more attention. We route these more complex claims to our specially-trained Complex Review Teams.  This way, we ensure each claim receives the appropriate care, while avoiding interruptions to our overall claims process.

Having a dynamic, highly educated, and experienced staff allows us to utilize our teams’ backgrounds to the greatest benefit of our claimants.  We have several teams that provide specialized review.  Staffed by nurses and legal professionals for example, these teams are able to draw upon their specialized skills and experiences when processing claims –yet another strength that elevates the NextClaim experience above the rest.