Third Party Administration
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Claims & Assistance
We focus on building long-term, sustainable relationships, with clients' and providers', built on a foundation of trust and quality, while leveraging technology and experience to improve outcomes for underwriters, and customers.
Inherent Risks is a force multiplier for your organisation.
Inherent Risks provides seamless Third Party Administration (TPA) services from First Notice of Loss (FNOL) to claims settlement, in the most popular tourist destinations, and the most remote regions around the world.
Third Party Claims Administration Platform
Combining extensive hands-on claims and insurtech experience, we have developed a proprietary Claims Administration platform, used daily by our own in-house team. Our platform is machine learning, and integrated with Artificial Intelligence, and as such is continually learning and improving, providing real-time claims data, proactive alerts and location specific risk-ratings. It is intrinsically linked to our proprietary case management platform, and conforms to all healthcare privacy and data protection laws.
First Notice of Loss
We believe that a combination of fast response times, trained and experienced staff, and thorough FNOL procedures are the most important part of the claim process. It quickly enables us to understand the policyholders' situation, and to provide immediate advice and direction to remedy any concerns and requirements. Our experienced 24/7 multilingual assistance platform is staffed by fully qualified and experienced medical and risk advisory specialists to validate policies, and provide a smooth claims process.
We have gained a reputation for identifying and uncovering even the most convincing of fraudulent claims, by both policyholders' and providers'. From lost baggage, to medical claims, to overinflated medical and assistance costs, our intelligence-led approach has led to millions in savings for underwriters. We combine in-depth desktop research, analysis and verification, with expert fieldwork and translation services, to offer flexible validation solutions; regardless of claim values or where an incident occurred.
A full 24/7 claims management solution, from first notice of loss, to claims validation, triage, medical assistance, settlement and multi-currency payments. Our proven model is supported by experienced claims handlers and a global medical network, as well as ground and air transportation providers with global coverage, even in the most challenging regions. Our team sets and manages expectations, providing clear and timely updates to policyholders and insurers.
We recognise that the accuracy of our clients’ bordereau is paramount, and we are proud to set ourselves apart from our competition when it comes to the accurate and timely provision of this fundamental element of TPA claims handling. Our Lloyd's compliant monthly bordereau reports provide in-depth data surrounding all payments made from fund accounts, with a full breakdown of financial movement on each claim along with the latest reserve figures.
We are all too aware that there is no 'one-size-fits-all' report when it comes to insurance. Through our in-house, purpose developed claims and reporting platform, we are able to offer our clients' a range of tailored reports that deliver on each individual insurer requirements. In addition, we can provide log-in access where this information is available immediately, mitigating the requirements of insurers' waiting to access their own data.
Inherent Risks retains multilingual medical doctors in key regions around the world to support our in-house medical case managers and coordinators, and who are on-hand to provide expert medical advice, and second-opinion, and/or to liaise with treating medical doctors abroad. Our case management team communicates with hospitals and patients, issues Guarantee of Payments (GOPs), provides immediate updates on medical diagnosis, treatment plans, and estimated costs to our clients, obtains (and translates) the relevant medical reports and Fit to Fly declarations, and coordinates medical escort and repatriation via commercial and air ambulance flights.
Our ability to assist and respond on behalf of policyholders is of utmost importance to us. In addition to our own in-house medical, security and crisis response expertise, we maintain a global network of tried, tested and trusted medical, security, transport, aviation, logistics and legal providers, all readily searchable by our Case Managers and Response Consultants via a proprietary Global Assistance Network platform. Our network providers are vetted, including sanctions checks, and are constantly benchmarked.
We believe that effective cost containment is a fine balance between minimising healthcare costs, while ensuring the required treatment is given, without compromising quality of care. Our team has extensive experience in providing cost-effective solutions to help manage exposure to healthcare risks and to limit catastrophic losses, by successfully intervening, during live cases, to ensure patients are not misdiagnosed or over-treated, and that medical treatment plans are suitable for the diagnosis. For cases where the patient has already been discharged, we confirm all medical reports, and audit all medical bills.
Global Payments Gateway
Using a combination of fintech and blockchain technologies, and through leveraging solid relationships with financial institutions built over several years, we have established a fintech solution to pay medical bills and travel expenses abroad. Through smart linked accounts around the world, this enables us to pay and receive funds in multiple currencies, across 120+ countries. In an age of digital disruption, our clients are constantly looking for new ways to increase their product offering, and reduce their fees. Our solution does both. It has significantly reduced banking and currency exchange fees on both sides of the transaction. Both payers and providers benefit.
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