Claims Management

ProClaim

  • “Concierge” service delivered by a technically proficient team
  • Integrated risk management services team focused on results
  • Proven business strategies to achieve significant program results
Design.Integrate.Achieve.

Get nationwide claims and risk management services dedicated to the healthcare industry. We understand your evolving needs and the importance of providing a well-coordinated and customized claims and risk management approach.

Design.Integrate.Achieve.

Solution Highlights

The ESIS ProClaim Experience

ESIS ProClaim applies a balanced approach to claims management that focuses on three key components:

Our People

ESIS ProClaim team members possess the experience and expertise needed to identify and service your distinctive needs. We are committed to:

  • “Concierge” service
  • Providing dedicated and proactive account managers experienced in healthcare professional and general liability claims management
  • A collaborative approach to structure each client’s program according to unique claims servicing requirements

Our Processes

ESIS ProClaim continually refines our approach to be sure our services are customized, complementary and complete. Highlights include:

  • Meticulous account implementation
  • Initial claims investigations conducted by certified nurse consultants
  • Established methodology for reserving
  • Professional claims and litigation management
  • Quality controls at every level

Our Technology

ESIS ProClaim’s proprietary risk management information system is designed to enable clients to track claims activities in real time. This means you, the client, are always in control. Features include:

  • Paperless environment for optimal viewing and transmittal of documents
  • Online access to financial information, claims activity, claims notes and up-to-date claims resolution plans
  • Flexible reporting capabilities

Business Segments Served

  • Hospital professional liability
  • Physician professional liability
  • Senior care professional liability
  • Medical devices and product liability
  • Pharmaceuticals
  • Biotech
  • Managed care E&O
  • Nursing professional liability
  • Employment practices
  • Cyber liability
  • Privacy
  • Data breach liability

Services Provided

  • Claims management
  • Litigation management
  • Medical investigations
  • National Practitioner Data Bank reporting
  • State reporting
  • MMSEA 111 reporting

Clinical Risk Consulting

Our Clinical Risk Consulting Practice specializes in providing clients with customized, client-focused consulting services that build on existing organizational strengths and complement ongoing safety and improvement efforts — while also addressing key areas of risk. We conduct careful diagnostics and analysis of your unique culture and attributes, as well as traditional gap analysis. We work with all segments of the healthcare market, including acute care hospitals, long-term care providers, behavioral health, physician practices, captive insurers, risk retention groups and brokers.

Clinical risk consulting services include:

  • Clinical improvement and risk reduction strategies
  • Program assessment and enhancement
  • Clinical process design
  • Critical event response support
  • Culture change and improvement
  • Safety management systems
  • Training

Claims Reserve and Financial Auditing

Your current claims management approaches may be effective — but how do you know? Enlisting the services of ESIS ProClaim, you can not only know how your claims are being handled, but also how quickly and how well. Our team of experts can assist you — working closely and collaboratively with your claims management team to understand their procedures and protocols. We look at key aspects of claims management to review compliance to current laws and industry best practices. In addition, we focus on critical details such as the establishment of accurate reserves, litigation management and a wide range of cost containment measures. Together, we identify opportunities for improvement. We help you face deficiencies head on and offer expert advice as you develop a workable action plan for your company — one that drives improvement and supports better claims outcomes overall.

Mediation and Trial Attendance

We bring a robust suite of specialized risk management services to the claims industry on a nationwide basis. Our professionals provide the expertise and skills required to tackle the unique and diverse challenges facing today’s mediation and trial monitoring environment. They apply a proven skill set to provide self-insured clients and insurance carriers with trial and mediation observation and analysis. Your time is valuable and ESIS’ ProClaim professionals work proactively to ensure a seamless continuity of service.

Investigation Services

In a perfect world, every claim would be settled in a relatively simple manner. But healthcare risk managers know we don’t operate in a perfect world. Many claims are complicated and require special attention and careful investigation of the facts. ESIS ProClaim knows that timely, thorough investigations provide vital information that helps our clients make informed decisions. We have both the experience and the resources needed to perform this critical function for you. All of our nurse investigators have Registered Nurse (RN) designations, and our field investigation offices are strategically located. Our goal is to apply our proven methodology, using both field staff and internal staff to complete the investigation process.

Organized in 1953, ESIS, Inc. (ESIS) provides customized risk management services. ESIS is a Chubb company. Chubb is the marketing name used to refer to subsidiaries of Chubb Limited providing insurance and related services. For a list of these subsidiaries, please visit our website at www.chubb.com. Chubb is the world's largest publicly traded property and casualty insurance group. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, life insurance and related services to a diverse group of clients. Chubb Limited, the parent company of Chubb, is listed on the New York Stock Exchange (NYSE: CB) and is a component of the S&P 500 index. Additional information about Chubb can be found at www.chubb.com. Additional information about ESIS, Inc. and its products and services can be found at www.esis.com.

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Learn more about ESIS' claims management solutions.