Care & Claims Management | Health & Benefits | Mercer

Care and Claims Management

  • 87%

    increase in frequency of health claims above $1 million from 2014 to 2017²

  • $3.30

    Average return on every dollar spent by Mercer’s care management solution clients³

How Care and Claims Management Protects You

With costly healthcare claims becoming more frequent, stop-loss coverage is vital to shield self-funded employers from large medical and pharmacy claims in any given year. Our comprehensive approach can help you with the right care and claims management strategy:    

  • High-cost claims oversight: Negotiated terms and conditions to limit the “lasering” of high-risk claimants year to year by carriers. That means you have more protection when it comes to renewal rates and high-cost claims.
  • Claims audit: In addition to placing coverage, we take a consultative approach. We will review your existing insurance coverage and work to identify gaps in coverage or non-competitive terms and conditions. Then we can help find appropriate coverage levels and ways to maximize your benefits and coverage.
  • Clinical and operational performance assessments: Necessary due diligence can evaluate vendor partner performance and manage high-cost claim irregularities. Regular third-party assessments provide a foundation for continuous process improvement toward better clinical and financial results.
  • Care management services: Solutions like Mercer Health Advantage™ deliver high-intensity care management for employees who have serious or chronic conditions and acute health needs. Our holistic approach can improve quality of care and health outcomes, while saving employers $430 annually per employee on average.³
Mercer Care & Claims Management Insights
Stay informed with Mercer’s latest news and research that impacts the health and benefits arena — with insights from our respected experts and thought leaders.
More Insights

 

          1  Mercer’s National Survey of Employer-Sponsored Health Plans

          2  2018 Sun Life Stop-Loss Research Report

          3  Results may vary

 

Contact Us
Find out how Mercer’s care and claims management solutions can keep your employee health and benefits program moving forward.