Clinical Services

Claims Management

Ryan Specialty Benefits believes the plan placement process is only one component of a self-insured employer’s total healthcare cost and risk financing strategy. We integrate claim cost reduction strategies with a consultative approach to deliver solutions specific to your clients’ needs. Our in-house clinical team identifies and deploys actionable strategies to achieve claims savings and cost containment results.

Ryan Specialty Benefits Complex Claims monitoring, facilitation, and management services:

• Saves your client administrative time and hassle,
• Ensures claims are submitted with accuracy,
• Improves the overall efficiency of the process,
• Provides access to in-house clinical team to support complex members,
• Expedites claim reimbursement, and
• Includes ongoing claims tracking, monthly report monitoring and year-end claim reconciliation.

We provide a complex claims management service that proactively monitors high-cost claimants. We produce reporting packages with a risk narrative that tells the full story. These packages provide meaningful metrics and data that help facilitate your client’s decisions. We train sales teams and offer ongoing sales support to ensure competitive advantages are recognized during the pursuit process.

In an environment where larger and more complex claims occur, claim denial frequency is increasing and reimbursement is uncertain, allow Ryan Specialty Benefits to support your client’s cost reduction strategy with our complex claims management expertise.

Care Management

Ryan Specialty Benefits understands how ongoing medical conditions or difficult diagnoses can be challenging for the plan member and employer. RSB offers your clients a suite of care management solutions that ease the uncertainty of navigating the current healthcare system.

Our in-house clinical team’s concierge service puts the plan members and their healthcare needs front and center while also using data analytics, proactive outreach, and preventative programs to tightly manage overall plan costs.

Ryan Specialty Benefits Care Management services:

• Work directly with plan members and employers to ensure quality and cost-effective care,
• Guide plan members through the complexities of today’s healthcare system,
• Determine healthcare utilization to minimize high-dollar claims and high-risk diagnosis, and
• Provide specialized programs for various health conditions.

To learn more about our specialized care management products, visit cmspecial.com.

Privacy Notice | Legal

The operations described in this document are provided by Ryan Specialty Benefits. Ryan Specialty Benefits is comprised of the following legal entities: Ryan Specialty Benefits, a series of RSG Specialty, LLC (In California, RSG Specialty Insurance Services, LLC, License #0G97516), AccuRisk Solutions LLC, Case Management Specialists, LLC, Matrix Group Benefits, LLC, and Matrix Risk Management Services, LLC. All of these entities are subsidiaries of Ryan Specialty, LLC. CMSI is a part of Case Management Specialists, LLC. Some products may only be available in certain states, and some products may only be available from surplus lines insurers. ©2024 Ryan Specialty, LLC