Since I already offered my “Valentine to Customer Service,” it’s time to name the other target for my heartfelt appreciation of The Alliance staff. This time, I’m aiming to give kudos to the claims
department.

Claims department staff are the unsung heroes at The Alliance; the worker bees that busily work in the background to receive, enter and reprice all the claims that travel in and out of The Alliance. They are always so busy working that they never stop to get the credit they deserve. This is where I come in because we all know I don’t mind tooting some horns.

The Claims Process

Due to the complexity of the self-funding claims process, claims staff are always working to meet a strict deadline so claims are discounted and out the door within three days.

3 steps of claims processing

Last year alone our claims department repriced 720,814 claims with an accuracy rate of 99.9 percent. This calculates out to 3,029 claims a day!

Claims numbers for 2013

Aiming for Accuracy

Our team is comprised of six individuals who aim for consistent turnaround by coming in over the holidays, snow days and even sick days.

As a result of their hard work, they received a 100 percent accuracy rating in a recent audit performed by Humana based on:

  • Turnaround time against contract requirements.
  • Pending claims and inventory reports for monitoring.
  • Provider contract review to validate practitioner participation and accuracy of repricing.
  • Review appropriate regulatory licensure.
  • Review policies and procedures to ensure compliance with Humana guidelines
  • Observance of Health Information Portability & Accountability Act (HIPAA) procedures.

Happy Members

Overall, the claims and customer service departments work hand in hand to ensure our self-funded employer members are happy with our provider network, provider contracting and discounts.

So next time you see a claim come in the mail with a dollar sign on it, think of The Alliance’s claims department and how they made sure you got The Alliance discount instead of paying the full amount. They truly help all our members save money, one claim at a time.

 

More about Claims and Customer Service:

Tierney Anderson

Tierney Anderson

Senior Marketing & Events Specialist at The Alliance
Tierney Anderson joined The Alliance in 2009 and currently serves as the cooperative's marketing & events specialist. She previously served as marketing and member services coordinator. Her responsibilities include the development of effective communications and marketing materials for Alliance members and business partners by executing marketing plans and promoting products, services and events.

In addition to her work at The Alliance, Tierney is an active member on The Business Forum, previously serving on the board and acting as senior chair for the ATHENA committee. Tierney also participates in the Advertising Federation of Madison and the Pancreatic Cancer Action Network of Madison.

Tierney earned her bachelor's degree of business administration from the University of Wisconsin-Oshkosh with an emphasis in information systems and a certification on the Project Management Body of Knowledge.

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