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Claims Administration and Processing

Fast, Friendly, and Efficient Claims Adjudication
Since 1958, Coughlin & Associates Ltd. has been a trusted provider of claims adjudication and payment services to Canadian plan sponsors. Our commitment to industry-leading standards ensures that your employees and members experience fast, friendly, and efficient claims processing.

Claims Administration and Processing

Fast, Friendly, and Efficient Claims Adjudication
Since 1958, Coughlin & Associates Ltd. has been a trusted provider of claims adjudication and payment services to Canadian plan sponsors. Our commitment to industry-leading standards ensures that your employees and members experience fast, friendly, and efficient claims processing.

Key Features of Our Claims Adjudication:

  • Timely Processing: Our claims adjudication team is trained to process dental, medical, life insurance, and short and long-term disability claims efficiently. Most medical, dental, and drug plan claims are processed within 5 days, providing swift resolution.
  • Pre-Authorized Deposit (PAD): Enjoy the convenience of direct deposit through our PAD reimbursement program. Claimants can receive electronic reimbursements within two to three days following the approval of their medical and dental claims, eliminating mail delays.
  • Convenience: Coughlin & Associates plan members enjoy the freedom of accessing plan information and submitting claims using our cutting edge app for iPhone and Android, or online via our plan member portal.

Claims Reporting Tailored to Your Organization

Coughlin takes pride in offering detailed claims reporting for plan sponsors. Our reports cover various aspects, including specific benefit utilization, amounts paid, eligibility levels, total claims by group, average claim turnaround time, and more. These reports can be customized to meet your organization’s unique requirements.

Fraud Prevention for Your Security

At Coughlin & Associates, we prioritize the security of your benefits plan. With rising concerns about benefit plan fraud, we apply industry-leading software and human resource solutions to actively identify irregular or suspicious claim or billing activity and conduct thorough reviews and investigations.

Simple Steps to Protect Your Benefits:

  • Ask Questions: Inquire about the costs of procedures, services, or equipment.
  • Review Claim History: Check the explanation of benefits for procedure costs and claim reimbursements.
  • Keep Records Secure: Safeguard your records, benefit cards, and personal identification to prevent fraud.

Disability Management Services

Coughlin boasts a dedicated team of disability management professionals who closely manage the file from the moment it’s reported. High touch communications allow clients and employees to know what is happening with their claims whilst ensuring appropriate treatment and care is in place and proactive return to work focus is maintained. We believe in the right care, at the right time for the right outcome!

Key Services Include:

  • Claims Investigation: Prompt and thorough investigation of case facts.
  • Objective Evaluations: Providing fair assessments when claims liability is established.
  • Payment Processing: Swift processing of claim payments from plan sponsor-funded accounts.

Industry-Recognized Expertise

Our disability claims administrators utilize industry-recognized reference material for assessments, backed by collaboration with medical consultants, psychiatrists, a national pharmacy benefit manager, a dental consultant, and a network of health care and legal resources.

Ready to streamline your claims administration? Contact us for efficient, secure, and expert claims adjudication tailored to your organization’s needs.

When it comes to client management, Coughlin has one, and only one, mission:

to provide Service Beyond Expectations in everything we do.

When it comes to client management, Coughlin has one, and only one, mission: to provide Service Beyond Expectations in everything we do.

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