What We Do

Claims Administration & Adjudication

on a Detailed, Individual Level

Robust Decision Support Tools;

Full Environment Support

Enhanced Efficiency for

All Users in the Industry

Healthier Employees make for a happier, more productive workforce. That's a given.

Sharply rising healthcare costs, along with growing complexity & regulations, are forcing many employers to take a hard look at how they deliver Healthcare Benefits to their valued employees. More and more, employers are outsourcing Healthcare Administration to control costs, enable movement toward consumer-driven healthcare, ensure that increasingly demanding compliance requirements are met, and free staff to focus on HR programs that drive growth.

SEB offers a range of robust service platforms, designed to meet companies’ specific health & welfare administration needs. These platforms power our solutions, enable innovative healthcare strategies, promote employee self-management and decision-making, and facilitate third-party interactions.

SEB’s Technology Platform provides the most flexible Automated Plan Designs in the Benefits Industry. Key features include:

  • The adjudication of health benefit claims on a detailed individual level, unique in the health claims processing industry.
  • A rules-based adjudication platform, in one technology environment, for all benefit types, versus the industry norm of multiple environments.
  • A fully-integrated technology environment; the most automated in the industry, able to implement and adjudicate the most detailed, flexible Benefit plans in the industry.
  • Administration software that integrates seamlessly with HRIS (Human Resource Information Systems), adjudication, payment processing, insurance carriers and reporting. Enhances efficiency for all users and is unique in the industry. Can be deployed as a module.
  • The most detailed reporting in the industry.
  • Self-service functionality, including real-time access to standard reports and data mining capability for customized reports.

Comprehensive Services

  • Automated Administration & Adjudication: Clients receive full enrollment support, including annual enrollment, new hires & life events info via the internet or Customer Service, thereby reducing manual errors & premium overpayments.
  • Improved Participant Decision-Making Process: Robust decision-support tools, including health plan comparison charts and benefit predetermination give participants what they need to make smart healthcare decisions.
  • Powerful Management Administration Tools: Plan information, eligibility reporting to carriers, enrollment, transactions & reporting - all contained in a single source.
  • Enhanced Visibility with a Comprehensive Reporting Package: Enrollments, census information, premiums & more are combined in a single report format to answer participants' questions about healthcare plan administration.
  • Simplified Benefit Communication: A full range of integrated communications support, including paperless enrollment, making the process simple and easy to understand for employees.

Administration Solutions

TBD

Rule-Based Platform

Our Rules-Based platform allows trained Administrators - not programmers - to create & implement new rules, without the rigors of typical software development.

Our Rules Engine is separate from the Adjudication Processing Engine.  All other Adjudication Processing Engines incorporate these rules directly into the Adjudication Processing Engine, which significantly reduces the flexibility to automate the processing of complex benefit environments.

SEB has a new approach to flexible healthcare plans, offering a wide range of flexible benefit solutions designed to meet the needs of every client. Our focus is on enhancing the value of plan member benefit dollars without increasing costs.  Our technology-driven benefit solutions provide the most flexible automated plan designs in the industry.  An important objective of ours is to put more control of each Health Care Dollar into the hands of the Plan Sponsor & Plan Member/Beneficiary.

SEB Administrative Services’ fully-integrated technology platform manages & adjudicates all benefit types in one technology environment.  Administration software is seamlessly integrated with adjudication & reporting, with self service functionality, including real time access to standard reports and data mining capability for customized reports.  While the modules operate as a fully integrated system, the administration & adjudication modules can operate stand alone.  The detailed real-time reporting functionality is optimum in the context of a total solution implementation.

Benefit Types

  • Prescription Drugs, Extended Health Care, Hospital Care, Vision Care, Dental Care, Paramedical Services, Stop Loss, Out of Canada Emergency Medical Coverage, Health Spending Account, Cost Plus, Dependent Life, Accidental Death & Dismemberment, Long Term Disability, Short Term Disability and Critical Illness.

Learn more about how we can help you achieve your goals.



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