Stop-Loss & Reinsurance
Advanced Reinsurance Architecture
Stop-loss is a critical financial hedge, not just a premium expense. We engineer risk structures that protect corporate capital from the volatility of high-cost claimants and systemic medical inflation.
Reinsurance Oversight
We act as a defensive advocate for the plan, applying oversight to CMS mandates and GASB requirements to ensure every transition is both financially defensible and member-focused.
Contractual Integrity & Alignment
Stop-loss coverage is only as secure as the underlying contract. By auditing policies against the medical Summary Plan Description (SPD), we eliminate the contractual gaps in eligibility and medical necessity that leave employers with a catastrophic liability.
Predictive Risk Surveillance
Reactive reporting is a financial liability. Utilizing continuous data feeds identifies high-cost claimants months before they appear on carrier reports, allowing for proactive clinical intervention and precise financial forecasting to defend the plan against bill shock.
Technical Recovery Advocacy
Independent verification of every claim filing against TPA data ensures 100% of eligible specific and aggregate recoveries are captured, insulating the plan from administrative leakage.
The Reinsurance Lifecycle
Strategic Market Shopping
We shop the market with a disciplined, data-driven approach. By leveraging our deep carrier relationships and forensic auditing, we ensure your stop-loss coverage is always placed with the most competitive and transparent partners available.
Strategic Replacement
We aren’t beholden to any specific carrier. We’re constantly evaluating your current partners to make sure they’re still the best fit for your plan's goals—and if they aren't, we find someone who is.
Shock Claim Detection
Our real-time analytics allow us to monitor for shock claims months before they appear on standard carrier reports. By identifying these high-stakes risks early, we give you the lead time necessary to adjust strategy and protect the plan’s reserves.
Market-Neutral Risk Strategy
Strategic placements must be market-neutral. By establishing an independent reinsurance architecture, plan sponsors can strip out bundled carrier bias and achieve a higher level of fiscal certainty.
Carrier Neutrality & Benchmarking
Access to a broad spectrum of A-rated carriers ensures placements are based on contract strength and pricing stability rather than carrier-integrated incentives.
Laser & Gap Mitigation
Aggressive negotiation is utilized to eliminate or minimize lasers on known claimants. Contracts are scrutinized for "experimental" language that could lead to claim denials.
Captive & Alternative Funding Analysis
For organizations seeking greater control, captive structures are analyzed to determine if retaining risk in a managed environment offers superior long-term financial outcomes.
Full Implementation Lift
Strategic advice is useless without execution. We join your team as an extension, providing the staffing and expertise needed to manage the transition and ensure the plan performs exactly as promised.
Results That Speak for Themselves
Unrecovered Claim Leakage
Month Advanced Risk Detection
SPD-to-Policy Alignment
Request a Strategy Audit
Move your plan from projections to performance.
We strip out the contractual friction in pharmacy, retiree healthcare, and stop-loss so you can stop paying for the noise and start enforcing the math.