This group of features provides the tools and infrastructure for a claims operations department to manage inventory and workload, as well as performing key tasks such as pend resolution, adjustments, auditing and claims inquiries.
Dashboards and reports are available to provide insight into the day to day operations and help identify trends.
The SCE supports inventory management by ensuring the right work is retrieved by the correct operators and that work can be transferred appropriately when needed.
The SCE supports pend management via a variety of tools. These include the ability to search for members and associated claims, a guided pend resolution process and support for mass reprocess when a high-volume issue is resolved.
|Adjustments & voids|
The SCE supports adjustments and voids utilizing the single and mass claims adjustment tools. Mass adjustments can also identify the impact and schedule the subsequent processing.
|Dashboards & reporting|
The SCE provides dashboards for both claim and system operations. Reports showing productivity and errors are also available. Individual and mass communications can be provided by the notifications and Pulse capabilities.
The SCE manages claims inquiries from initiation through completion with a robust case management model.
The SCE provides configurations for random audits for claims and examiner work. This ensures that claims are adjudicated correctly.