Claims Adjudication

Companies strive to achieve the highest quality, cost, speed and accuracy of their claims service. AEMERUS will assess a claims operation to identify opportunities for improved performance across all metrics. We have provided significant recoveries for companies by identifying leakage from faulty source data, incorrect contract loading, inefficient quality oversight and auto adjudication errors.

We provide action plans to reduce backlog, reduce and stabilize overhead costs, manage work-flows and improve financial and procedural integrity. Improvements to a claims operation not only reduces overhead, it also improves customer satisfaction and enhances customer retention.

Enrollment and Eligibility

Accurate and enrollment and eligibility processes are central to a well run employee benefit plan. Inefficient process can result in claims overpayment, reduced revenue collection, wrongly denied claims, poor customer satisfaction levels and ultimately, regulatory sanctions. AEMERUS can assess and provide improvement plans to ensure appropriate policies, procedures and controls are in place to improve performance in this important area.

Customer Service

In today’s highly competitive environment, customer retention is essential. An organizations ability to retain customers is often directly related to the effectiveness of the service provided by the contact or call center. AEMERUS can help organizations dramatically improve their call center and customer service units from reactive old generation departments to new generation, proactive contact centers. We understand the science of contact center management, the processes, the technology and strategies that support cost-effective customer satisfaction.