Overview of Services

Benefits 1 Group provides third party administration services designed to enhance your health care benefits package while helping you contain costs and eliminate bureaucratic hassles. From plan creation, to workers’ compensation claims management, Benefits 1 Group is the employer’s one stop source for coordinated employee health, disability, and workers’ compensation benefits needs.

Our approach is personalized, knowledgeable and responsive. We employ a three-pronged service approach that includes:

• Accident and Loss Prevention which includes periodic safety inspections; OSHA record keeping consultation, regulation compliance, and citation defense; and ergonomic assessment and remediation,
• Financial Oversight including underwriting or manual classification review; group rating analysis; retrospective rating evaluation; self insurance studies; and business planning, and
• Claims Management including evaluation of ongoing claims from previous experience periods; assistance in the new claim certification decision process; active involvement with both the employer and the health care provider to accomplish early return to work of injured workers; assistance obtaining appropriate medical care for injured workers; implementation of independent medical exams and other cost control measures where appropriate; and assistance in early prevention of costly and time consuming litigation.

The managed care system is complex.  But you don’t have to be overwhelmed by its complexity.  Let Benefits 1 Group help simplify the system for you.  Give your employees the care they deserve, at a cost you can afford.

Self Insured Employers

For self-insured employers, Benefits 1 Group services also include appropriate focus on resolving issues specific to their space. Excess or stop loss insurance, risk management, benefits payment, and regulatory documentation are all of part of the services available to self insured employers.

Our Self Insured TPA Services include:

• Accident and Loss Prevention
  • Periodic Safety Self-inspection
  • OSHA Record Keeping Consultation
  • OSHA Regulation Compliance
  • OSHA Citation Defense
  • Ergonomic Assessment and Remediation
  • Computer-based Accident and Injury Analysis
• Financial Management
  • Assimilate prior claim financial records into our MIS database.
  • Work with Agent or Broker to obtain excess or stop loss insurance.
  • Submit periodic claim reports to Excess Carrier.
  • Produce accurate periodic loss run reports to risk management.
  • Provide case management reports to the risk, their bank or both.
• Claim Management
  • Evaluate all established claims with ongoing payments for control possibilities.
  • Assist in new claim investigation and reporting.
  • Actively work with QHP or medical providers to obtain an early return to work. We achieve this by arranging prompt medical care.
  • Calculate and document the FWW and/or AWW.
  • Calculate and pay correct compensation.
  • Work with QHP or medical providers to pay appropriate medical benefits on a timely basis.

State Funded Employers

Our State Fund TPA Services include:

• Accident and Loss Prevention
  • Periodic Safety Self-inspection
  • OSHA Record Keeping Consultation
  • OSHA Regulation Compliance
  • OSHA Citation Defense
  • Ergonomic Assessment and Remediation
  • Division of Safety & Hygiene
• Financial Management
  • Underwriting or Manual Classification Review
  • Group Rating Analysis
  • Retrospective Rating Evaluation
  • Self Insurance Studies
  • 10 Step Business Plan
  • Calculate Internal Merit Rating Where Viable
• Claims Management
  • Evaluate all established claims with ongoing payments that are in the experience period.
  • Assist in the new claim certification decision.
  • Actively work with MCO and Bureau employees to obtain early return to work of injured workers.
  • Help install a transitional duty program where appropriate.
  • Work with other MCOs to obtain appropriate medical care for any injured worker.
  • Obtain independent medical examinations and other control measures when needed.
  • Work with the interested parties to avoid the disruption, cost, and hostility caused by preventable litigation.

Workers' Compensation Expertise

In workers’ compensation, a legacy specialty area of Benefits 1 Group, Benefits 1 has world class expertise dealing with the special complexities of that system. The Benefits 1 executive team is comprised of former senior managers from the regulatory side. Most have extensive experience as Hearings Officers and in hearings settings. They know the inside story on how hearings work, and how parties win.

To learn more about our team of experts, click here.