Our investment in innovative technology and partnership with unique industry leaders is helping improve the quality of clinical outcomes and reducing the cost of healthcare more>

Our Focus

Our investment in innovative technology and partnership with unique industry leaders is helping improve the quality of clinical outcomes and reducing the cost of healthcare.

As healthcare costs continue to increase, employers need tangible cost containment solutions. We offer our clients multiple state-of-the-art loss control technologies to achieve results.

• Reducing healthcare claims expense by identifying areas of potential fraud, abuse or overpayment is a key element in cost containment. Claims are scrubbed using data-driven analytics that accurately identify inappropriate activity, and accelerate payment for claims that should be paid.
• Using predictive technology to identify emerging risk allows our physician specialists to work peer-to-peer with attending physicians and proactively address the patients' needs.
• Managing out-of-network claims by using subcontracted fee schedules or peer-to-peer negotiation with the medical provider.
• Capturing claim information and permitting access to authorized risk managers and reinsurance specialists through a single, secure, HIPAA compliant platform to improve risk management strategies.

Since the passage of HIPAA, the demand for electronic claim transactions has increased prompting greater use of auto adjudication for claim payments. Unfortunately, many administrators lack the audit and control systems needed to catch sophisticated schemes and, as treatment becomes more individualized, claim billing has become more complex.

Through proprietary software, our medical management team selects claims that meet the clinical and financial algorithms for validation by a physician. Our loss control technologies combined with physician review helps manage risk and payment integrity while effectively reducing the cost of healthcare.

Stirling Benefits is committed to delivering exceptional value to our clients by positively impacting the high cost of medical exposures. We possess significant capabilities to meet today's healthcare challenges offering solutions through experience, responsiveness, and flexibility.