Claims Administration

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Rely on Our Expertise in Claims and Service 

Our experienced team conducts all claims administration services onsite. We have regional claims processing and service centers in Irvine and Fresno and have direct oversight to review calls, audit claims and routinely check for accuracy. SSAE Type I and Type II compliance reports verify our company is meeting the highest industry standards to offer you the best in quality service and performance. You can count on accurate and cost-effective claims processing with our state-of-the-art proprietary claims processing system.

Electronic Claims
We receive over 90% of our claims through an electronic data interchange (EDI), which allows us to automatically process claims based on your specific plan. Our claims examiners review each submission to identify any potential errors and address special circumstances requested by the client. We electronically transmit eligibility and claims information daily, allowing for quick payment.

Performance Standards
Our corporate culture emphasizes high standards and professional principles. As a customer-centric organization, we strive to exceed your expectations. We adhere to stringent claims processing performance standards and maintain a strong customer service philosophy.

HIPAA Compliance
The Health Insurance Portability and Accountability Act (HIPAA) was created to protect your personal information and privacy. We adhere to industry standards for transmitting, utilizing, disclosing and safeguarding confidential medical information to ensure compliance.

Online Tools
Whether you’re an employer, plan participant, broker, or provider, you can access the health benefit information you need using our proprietary online tools.

Customer Service
Our bilingual customer service representatives are knowledgeable about your individual health plan and can give accurate, timely, and personalized information. We track performance standards and provide quarterly reports to our clients, as requested.



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