Benefits & Claims Administrations

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EbixEnterprise Claims is a robust, end-to-end platform designed to automate and simplify health and voluntary benefits and claims administration.

Overview

Built for insurance carriers, payers, and third-party administrators, the solution significantly increases automation, lowers costs, and increases operational efficiency without compromising accuracy or regulatory compliance.

Discover
What’s Possible

Get in touch with our team for a personalized demo or free consultation. We’ll show you exactly how our solutions work and how they help overcome the challenges of outdated systems. REACH OUT

Comprehensive Support Across All Major Lines of Business

With integrated medical & financial management, EbixEnterprise Claims goes well beyond basic claims processing. The system offers built-in tools for utilization, case, and disease management, ensuring better care coordination and cost control. The platform also features advanced billing and financial management, along with a comprehensive reporting suite that delivers real-time insights and helps drive smarter and quicker decisions.

A Smarter Way to Manage Claims

With EbixEnterprise Claims, your organization will gain a single, scalable solution that brings together automation, accuracy, medical oversight, and compliance - all in one place. The result is lower administrative costs, faster claims processing, and a dramatically improved experience for clients, employees, members, and providers alike.

Key Highlights

EbixEnterprise Claims delivers a robust set of features designed to enhance efficiency, improve accuracy, and ensure compliance across all areas of claims and benefits administration.

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DOCUMENT MANAGEMENT WORKFLOW

Integrated document imaging for fast, secure access to claims documentation

Integrated document imaging for fast, secure access to claims documentation

 

Electronic workflow to streamline processing and reduce manual touchpoints

 

Electronic family files, including images, to support efficient and informed customer service

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Financial Management

Accounting-based core functionality ensures accurate claims and premium reconciliation

Accounting-based core functionality ensures accurate claims and premium reconciliation

 

Consolidated billing for both group and individual coverage

 

Electronic funds transfer (EFT) for secure, timely payments to providers, participants, and vendors

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Plan Flexibility & Auditing

Unlimited configuration of benefit plans to support diverse product offerings

Unlimited configuration of benefit plans to support diverse product offerings

 

Detailed auditing capabilities for transparency and internal controls

 

Customizable explanation of benefits (EOB) with web-based delivery options

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Medical Management & Compliance

Complete medical management solution, including utilization review, case
 management, and disease management

Complete medical management solution, including utilization review, case
 management, and disease management

 

Government compliance tools built into the platform

 

Fully HIPAA-compliant EDI solution for standardized, secure data exchange

For Carriers & Payers

Optimize Claims Processing, Improve Cost Control, and Deliver Superior Member Experiences.

Healthcare payers must balance operational efficiency, cost containment, and compliance while providing a seamless experience for providers and members. EbixEnterprise automates the entire claims lifecycle, from intake to adjudication and payment, ensuring faster, more accurate processing with built-in fraud detection, utilization management, and government compliance. With powerful data analytics and reporting, payers gain actionable insights to optimize financial performance and drive better health outcomes—all while ensuring a frictionless experience for members and providers.

Key Benefits

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Improved Operational
Efficiency

Automated workflows, claims adjudication, and electronic payments streamline administrative processes, significantly reducing manual work and operational overhead. This leads to faster processing times, more accurate claims, and lower administrative costs.

Automated workflows, claims adjudication, and electronic payments streamline administrative processes, significantly reducing manual work and operational overhead. This leads to faster processing times, more accurate claims, and lower administrative costs.

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Seamless
Compliance

The system supports government regulations, ensuring carriers and payers remain in full compliance with industry standards without the risk of penalties.

The system supports government regulations, ensuring carriers and payers remain in full compliance with industry standards without the risk of penalties.

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Real-Time Reporting and
Analytics

Advanced reporting tools provide real-time data insights into claims trends, financial performance, and operational efficiency. This empowers carriers and payers to make data-driven decisions, optimize workflows, and improve financial performance.

Advanced reporting tools provide real-time data insights into claims trends, financial performance, and operational efficiency. This empowers carriers and payers to make data-driven decisions, optimize workflows, and improve financial performance.

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Cost Control and
Containment

Medical management tools such as utilization review, case management, and disease management help identify and address unnecessary care, reducing healthcare costs. The system’s ability to analyze claims trends and identify inefficiencies enables proactive cost containment strategies.

Medical management tools such as utilization review, case management, and disease management help identify and address unnecessary care, reducing healthcare costs. The system’s ability to analyze claims trends and identify inefficiencies enables proactive cost containment strategies.

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Improved Financial Management

Integrated accounting functionality and consolidated billing simplify premium collection, payment processing, and reconciliation. The system also supports electronic funds transfers (EFTs) to speed up payments and ensure accurate financial transactions.

Integrated accounting functionality and consolidated billing simplify premium collection, payment processing, and reconciliation. The system also supports electronic funds transfers (EFTs) to speed up payments and ensure accurate financial transactions.

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Fraud Prevention and
Auditing

Detailed auditing capabilities and fraud detection tools minimize the risk of claims fraud, ensuring that carriers and payers can easily monitor, track, and resolve discrepancies or fraudulent activities.

Detailed auditing capabilities and fraud detection tools minimize the risk of claims fraud, ensuring that carriers and payers can easily monitor, track, and resolve discrepancies or fraudulent activities.

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Scalability
and Flexibility

The system supports an unlimited range of benefit plans, allowing carriers and payers to easily manage a diverse array of health plans, from individual to group policies, without needing separate systems.

The system supports an unlimited range of benefit plans, allowing carriers and payers to easily manage a diverse array of health plans, from individual to group policies, without needing separate systems.

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Improved
Health Outcomes

By integrating medical management tools, payers can focus on promoting better health outcomes through effective case and disease management, improving overall population health while controlling long-term costs.

By integrating medical management tools, payers can focus on promoting better health outcomes through effective case and disease management, improving overall population health while controlling long-term costs.

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Enhanced Member and
Provider Experience

By integrating medical management tools, payers can focus on promoting better health outcomes through effective case and disease management, improving overall population health while controlling long-term costs.

By integrating medical management tools, payers can focus on promoting better health outcomes through effective case and disease management, improving overall population health while controlling long-term costs.

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Faster Time
to Market

The system’s flexibility and integration allow carriers and payers to quickly adapt to new regulatory changes or launch new products, reducing time to market for new plans or services.

The system’s flexibility and integration allow carriers and payers to quickly adapt to new regulatory changes or launch new products, reducing time to market for new plans or services.

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Customizable Explanation
of Benefits (EOB) and web-based
delivery

Customized EOBs whether generated by our platform and delivered via the Web or delivered through one of our several fulfilment vendor partners.

Customized EOBs whether generated by our platform and delivered via the Web or delivered through one of our several fulfilment vendor partners.

Third-Party Administrators

Enhance Efficiency, Reduce Costs, and Scale with Confidence.

TPAs need a flexible, high-performance claims administration system that simplifies complex workflows while ensuring accuracy and compliance. EbixEnterprise streamlines claims processing, automates benefit administration, and integrates medical management, billing, and reporting—all within a single, scalable platform. With electronic workflows, automated payments, and real-time auditing, TPAs can reduce administrative overhead, improve turnaround times, and enhance client satisfaction while maintaining strict regulatory compliance.

Key Benefits

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Streamlined Claims
Processing

Automated claims adjudication and electronic workflows significantly reduce manual intervention, speeding up claims processing and ensuring greater accuracy, leading to faster turnarounds and improved client satisfaction.

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Efficient Benefits
Management

Integrated benefit administration for multiple plan types (health, dental, vision, HRA, HSA) within a single platform allows TPAs to manage the accounting, billing, and claims of complex benefit structures easily, without the need for multiple systems.

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Customizable and Scalable
Solutions

The system supports unlimited plan designs and can be tailored to meet the unique needs of different clients, allowing TPAs to offer flexible, personalized solutions and scale as client demands grow.

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Enhanced
Client Service

With features like electronic family files, customizable EOBs, and real-time reporting, TPAs can offer superior service to their clients, ensuring quicker responses and clearer communication.

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Improved Financial Management

Integrated billing functionality and electronic funds transfers (EFTs) enable accurate, consolidated billing for groups or individuals, reducing errors and ensuring timely payments to vendors, providers, and participants.

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Regulatory
Compliance

The system’s built-in HIPAA compliance, ICD-10 readiness, and government regulation support ensure TPAs remain compliant with healthcare regulations, reducing legal risks and the administrative burden of keeping up with changing laws.

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Cost Control and Fraud
Prevention

Advanced auditing capabilities and fraud detection tools allow TPAs to quickly identify discrepancies or fraudulent claims, helping to control costs and maintain integrity within the claims process.

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Comprehensive Medical
Management

Utilization review, case management, and disease management tools help TPAs manage healthcare outcomes, reduce unnecessary spending, and support employee/member well-being by proactively managing care.

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Scalability
and Adaptability

The platform’s scalability means TPAs can easily expand their operations, adding more clients or benefit plans without the need to overhaul their infrastructure, and can quickly adapt to market or regulatory changes.

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Improved Reporting and
Analytics

Real-time data analytics and comprehensive reporting provide TPAs with actionable insights into claims performance, financial metrics, and trends, enabling better decision-making and improved operational efficiency.

Contact Us

Please submit your information below or call us at (800) 872-7848

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