SIHO Insurance Services

Account Management:

  • The Account Management Department is responsible for developing and maintaining relationships with employer groups, brokers and consultants.  The department is also responsible to do the following:
    • Meet quarterly with the employer to present and explain financial reports regarding the plan.  Report on SIHO activities relative to service levels, claims expense and exposure, benefit issues, and other topics deemed important to the client.
    • Prepare for and conduct client orientation and open enrollment sessions for clients.
    • Communicate client issues to the appropriate SIHO departments.  Follow up to ensure timely resolution.
    • Lead implementation process for new accounts.

Employer Services:

  • The Employer Services Department coordinates with the Account Management Department as a resource for brokers and employer Human Resource departments to address service issues and answer day-to-day questions on items such as benefit education, claim issues, eligibility and billing questions. The Employer Service Department also creates and implements Corrective Action Plans alongside other internal departments to ensure the highest level of customer satisfaction.  Another major function of Employer Services is to research, prepare and present appeals to a committee to determine whether or not the claim should be upheld or overturned.

Finance:

  • Finance has two major roles within the company; the first role is to support the TPA and fully insured business operations.  The second role is the traditional accounting and reporting functions that maintain control over Company assets, establish budgets, prepare reports and financial statements for management, the Board of Directors and the State Department of Insurance.

Information Technology:

  • The Information Technology (IT) Department is responsible for the support, development and quality assurance of all SIHO’s systems and hardware.

Medical Management: 

  • Using an integrated quality management framework SIHO has developed an aggressive medical management program.  The SIHO Medical Management Program (MMP) is composed of three distinct activities:  utilization management, case management and disease management.  The Medical Management Program Description, along with the related policies and procedures, are intended to detail the key work processes for each activity.  Each activity is intended to work in tandem to establish, coordinate and execute a structure to support SIHO members as they work to become wise healthcare consumers. 

Project Management:

  • The project management department is headed by the Director of Project Management. Some prior work has included working with our largest client on various change requests, streamlining operations, and implementing IT systems. 

Provider Relations:

  • The Provider Relations department consists of multiple business units that work in concert to integrate SIHO’s provider aligned strategies. The department is designed to be cross-functionally flat working environment where each business unit has the ability to share staff, resources and expertise to add value to each of the business unit’s mission and goals.

Public Relations (Includes Facilities):

  • An organization’s reputation, profitability and even its continued existence can depend on the degree to which its targeted “publics” support its goals and policies.  Public relations specialists serve as advocates for businesses, nonprofit associations, universities, hospitals, and other organizations, and build and maintain positive relationships with the public. 

Sales:

  • SIHO’s sales department educates brokers and employers on SIHO’s products and services through sales presentations.  The sales team works with brokers and employers to develop cost effective benefit plans.  The department is responsible for developing and implementing a comprehensive sales plan, to include prospecting, qualifying, calling, presenting, and closing strategies.  They are also responsible for developing broker networks to extend and expand SIHO’s influence throughout the state.

Client Services:

  • Eligibility
    • All tasks involving the time spent on an active plan
    • ID cards
    • Cobra
    • Flex and HRA Enrollments
  • Member Service – Call Center
    • Voice of SIHO to the enrollees
    • Written correspondence and emails
  • Claims Processing
    • Claims transactions
    • Edit and Post Eagle claims
  • Ancillary Products
    • Claims transactions
    • Tracking and filing Reinsurance claims
    • Reviewing third party liabilities
    • Recovering funds paid in error
    • Coordination of Benefits

Fully Insured:

  • The Fully Insured department is responsible for marketing, new group implementation, existing group maintenance, managing agent relationships and product development.  Products are sold almost exclusively through appointed outside agents.  Agents are paid a commission for their SIHO subscribers through a capitated or percentage premium arrangement.  The administration of the product includes generating quotes, renewals, ID cards, coverage certificates, maintaining eligibility, and generating COBRA, Dependent, HIPAA, SBC and Medicare Part D notices.