Specifications include, but are not limited to: ● Claims Intake and Registration: Establish and maintain a centralized claims intake system to receive and register claims promptly and accurately. Coordinate the transfer of information and tail claims from our existing service provider. Ensure the availability of multiple channels (e.g., online, phone, mail) for claim submission to enhance accessibility and convenience. Validate claimant information and verify claim eligibility for further processing. ● Claims Evaluation and Adjudication: Thoroughly review and evaluate submitted claims, including supporting documentation, to determine claim validity, coverage, and compliance with legislation, regulations, and CORMA/agency policies. Adjudicate claims fairly and objectively, ensuring consistent application of established criteria and principles. Communicate claim decisions to the agency and claimant promptly and provide instructions for further steps, if applicable. ● Claims Processing and Payment: Process approved claims efficiently and accurately, ensuring timely and accurate disbursement of claim payments. Maintain robust financial controls to safeguard public funds during claim payment processing. Comply with all necessary documentation, reporting, and record-keeping requirements. ● Customer Service and Communication: Establish a dedicated customer service team to promptly respond (within 48 hours) to agency and claimant inquiries and resolve issues related to claims administration. Provide clear and consistent communication throughout the claims process, keeping agencies and claimants informed about the status, estimated timelines, and any required actions. Ensure that agencies and claimants have access to accurate and up-to-date information on claim submission requirements, processes, and available support.
