Canadian Benefits Consulting Group
Customizing Claims Processing

The modern insurance claims process is increasingly complex, with more variables pushing businesses to rapidly determine appropriate settlements and flag potential fraud. Companies seek experienced third-party providers (TPP) with a proven track record in effective and timely claims adjudication to avoid improper claims handling.

Canadian Benefits Consulting Group facilitates a seamless and effective claims settlement process with its comprehensive expertise as a third-party provider for over four decades. Acting as a full-spectrum service provider between the client and insurance company, it leverages its claims processing systems to promptly and accurately support all claimant needs, by accommodating union client needs with regard to input, service standards, claim administration, and reporting.

Today, Canadian Benefits has clients across Canada, working mainly with the union and non-profit plan sponsors with 700 to 7,000 members. It handles all the different needs of its varying clientele through specialized experts who add their experience to its growing knowledge base.

"We manage all administrative tasks and claims processing for extended healthcare and drugs, dental, and disability plans through our seasoned group of benefits specialists and insurance professionals on staff," says Roy Rastrick, president and CEO of Canadian Benefits Consulting Group.

There is a surging prevalence of mental disorders in Canada, pre- and post-COVID, leading to the highest claim ratio on mental illnesses in the past year (46 percent of a sample comprising 7000 people submitted claims for mental health issues). Canadian Benefits specializes in this area, hiring a full-time physician who manages mental health disability claims and provides policyholders and organizations with a wealth of knowledge.

One of Canadian Benefits' core differentiators is its collaboration with Union Benefits Trusts. Unlike many other third-party administrators that handle and administer claims but cannot issue payments, Canadian Benefits pays claims on behalf of some of Canada’s largest insurance carriers via insurer cheques and bank drafts.

Another facet setting Canadian Benefits apart is its emphasis on carefully assessing every client engagement to maintain its integrity and reputation. Understanding client needs and market trends enables it to create a customized approach, efficiently handling claimant payments.

Simultaneously, it stays abreast of the latest market trends and has a good rapport with other vendors, which helps it work on areas beyond its expertise, such as pension legislation. Canadian Benefits is also authorized to utilize insurance carrier systems, enabling it to offer a one-stop shop that makes claims processing seamless.

"When we talk to potential clients, we don't give them a box and expect them to fit in it. We ask them what box they have, and we will make it work," says Joyce Strasbourg, chief underwriter and business development officer of Canadian Benefits Consulting Group.

We manage all administrative tasks and claims processing for extended healthcare and drugs, dental, and disability plans through our seasoned group of benefits specialists and insurance professionals on staff

Canadian Benefits provides data, information, and analysis about the implications of a plan to ensure informed decision-making. They start every client engagement by listening in order to provide their clients with a comprehensive evaluation of their needs, followed by a Service Agreement that explicitly states the requirement for both parties to agree to meet no less than once every four months after the initial onboarding. During these meetings, they provide clients, usually Trustees with tailor-made solutions that work for them instead of overwhelming them with all possible options.

As an example of Canadian Benefits’ approach, one of their clients recently had an unexpected insurance benefit circumstance and was unsure how to handle it. During this engagement, Canadian Benefits negotiated with them to ensure the delivery of desired outcomes even when the circumstances did not fit any predetermined categories. Essentially, Canadian Benefits distributed the client's plan across four carriers and ensured hassle-free claims handling through impeccable coordination of disparate systems and processes through their simplified administration.

Due to its specialized team of highly competent medical claims examiners with a deep understanding of adjudication framework rules and unmatched industry know-how, Canadian Benefits remains a leading player in the Canadian claims processing space. Moving forward, they aim to continue providing enhanced claims and benefit consulting services supported by solid work ethics, technical knowledge, and transparency