Connected claims technology helps accelerate benefit payments for critical illness, accident, and hospital indemnity coverage
Sun Life U.S., a leading provider of employee and government benefits, and Claritev, a healthcare technology, data and insights company, are working together to bring more efficiency to supplemental health coverage offered by self-funded employers. Claritev’s machine-learning technology helps find diagnosis connections between employees’ medical claims and supplemental health coverages – which include critical illness, accident and hospital indemnity – to help covered employees access the benefits they are eligible for.
“Bringing Claritev’s services to self-funded clients will help connect the dots between health plans and supplemental health coverage, leading to more cohesion across employee benefits,” said Joi Tillman, president, Group Benefits, Sun Life U.S. “With Claritev, we can take a more proactive approach to helping employees get the payments they need when facing a major illness or injury.”
Self-funded employers fund their own health plans, and use a health insurer or third-party administrator to administer their employees’ medical claims. When a high-cost claim arises, many self-funded employers rely on stop-loss insurance to manage the risk. As one of the largest providers in the U.S. of medical stop-loss insurance, Sun Life is uniquely qualified to understand the ongoing needs self-funded employers face when managing their health and benefit plans.
“We want to bring self-funded clients more capabilities and solutions that help their health plans work better for their employees,” said Jen Collier, president, Health and Risk Solutions, Sun Life U.S. “Claritev’s innovative approach gives self-funded employers a strong tool to ensure Sun Life’s supplemental health benefits meet employees where they are.”
While employees are focused on managing their health needs following a medical event, accessing all available benefits is not always top of mind in the moment. Claritev’s model enables Sun Life to proactively engage employees when they are eligible for supplemental health benefits, helping them receive greater financial support during a time of need.
“Accessing supplemental health benefits should be simple and seamless,” said Jeff Caldwell, vice president, Sales, Claritev. “Claritev’s technology helps identify eligible medical claims earlier, which can help Sun Life deliver a more streamlined supplemental health experience to brokers, employers and employees when it matters most.”
Claritev offers a comprehensive solution that provides flexibility across medical plans. Once employees are enrolled in their supplemental health benefits, their medical claim data is reviewed on an ongoing basis. Claritev’s solution reviews claim data and helps identify employees eligible for supplemental health benefits. Sun Life then notifies clients’ employees so they can file the appropriate claims. All processes are secure and HIPAA compliant, prioritizing privacy and protection for employees.
Claritev’s capabilities are available to any self-funded employer offering Sun Life supplemental health coverage. The employer does not have to be a Sun Life stop-loss client.
Now available for quoting by Sun Life representatives for policies effective January 1, 2027, and later. Claritev is not available to Sun Life clients in New York. Learn more about Sun Life supplemental health benefits.
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