Workflow · Employee Health & Benefits
Claims Analysis
Runs the periodic claims experience review: validates the carrier or TPA claims reports, computes the financial picture — loss ratio, per-employee-per-month cost and trend, medical/pharmacy split, high-cost claimant concentration — and packages the findings so renewal preparation, strategy, and modeling work can use them directly.
What goes in
The client, plan(s), funding arrangement, and analysis objectives; the claims materials — monthly claims experience reports, large or high-cost claimant reports, enrollment counts by month, premium or budget-rate schedules, stop-loss terms, and any prior claims analyses.
What you get
A Claims Experience Analysis as a Word document: executive summary with the analysis mode and the most material findings, data quality and limitations, the computed claims financial summary with basis and period labels, de-identified high-cost claimant analysis, trend analysis, classified findings, implications for renewal and strategy, and recommended next steps.
How it works
- 1Establish the engagement: confirm the client, plan, funding arrangement, experience and comparison periods, and objectives in one organized intake.
- 2Validate the data: monthly claims, enrollment, and high-cost claimant detail are extracted from the reports, with each report's basis and period identified before anything is compared.
- 3Compute the picture: totals, per-employee-per-month costs, the medical/pharmacy split, loss ratios, trend, and high-cost claimant concentration are calculated from the validated data.
- 4Interpret: every material finding is classified — favorable, in line, adverse, or emerging risk — with its driver and what it means for the renewal.
- 5Deliver: a Claims Experience Analysis as a Word/PDF document with the financial summary, de-identified high-cost claimant analysis, trend, and renewal implications.
Related pages
What this workflow delivers
A Claims Experience Analysis as a Word document: executive summary with the analysis mode and the most material findings, data quality and limitations, the computed claims financial summary with basis and period labels, de-identified high-cost claimant analysis, trend analysis, classified findings, implications for renewal and strategy, and recommended next steps.
3+ hours
- Guided step by step, no blank page
- Owners and follow-up on every run
- Human review before sign-off