Claims / Risk Control

Experience a unique level of commitment.

A Standard of Superior Claims Support

When there’s a claim, experience makes all the difference. The experience of the people handling the claim, and the experience you and your clients have in the process. Our in-house HMO Reinsurance Claims Team brings years of specialized expertise to the process, and combines it with a thorough understanding of the business and operational issues facing our insureds.  This experience is then teamed with an unwavering commitment to service excellence. 
  • We provide you with a secure FTP site to send all claims information. 
  • E-mails and calls get a response within twenty four hours. 
  • Submissions are acknowledged within twenty four hours. 
  • Clean claims will be turned around within thirty days of receipt. 
  • Appeals will be turned around within five business days. 
  • Correspondence (letters, claim calculation reports, EOBs and reimbursement) will be forwarded to your designated contact on a timely basis to keep the process moving forward. 

Our dedicated HMO Reinsurance Claims Team is integrated with OBPI’s underwriting, actuarial, finance, and senior management teams.  This highly coordinated and precise approach to claims ensures your clients’ unique needs are specifically addressed.  The result is a claims experience that is entirely better for everyone.

If you’d like to know more, or would like some real-life examples showcasing our claims expertise, please contact Doug Bloomquist, Assistant Vice President, Claims, at dbloomquist@onebeacon.com

Claim Management Services

OBPI claim management services include:

  • Access to physician review and referral services
  • Access to network management services, including out-of-area networks, wraparound plans, national transplant networks and neonatal networks
  • Access to financial management services,  including bill review and re-pricing services, subrogation services and fraud and abuse identification and protection
  • Access to a nurse consultant for assistance with cost containment programs and services

Need more information?    Please click on any of the links below to get the material you need – when you need it.