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We do more than just pay medical claims or manage benefits. We are committed to driving quality outcomes and uncommon results. Through our unique philosophy and approach, Total Health Management®, we create trusted relationships with our clients because we engage as partners and not just as another vendor. We customize solutions that strike the right balance between keeping healthcare affordable without compromising on value. The key to striking that right balance is in how we manage all the moving parts that make controlling healthcare costs so complex, by analyzing the intricate details of our clients’ healthcare expenses, and designing solutions that we know work for both clients and members. Our holistic perspective incorporates data analysis, member education, and preventive care incentive programs to save costs, build a culture of health, and ultimately support a healthier, productive, and engaged workforce. We also understand that clients choose us to be their preferred partner because we treat our member interactions as great service experiences for members, and not as just another transaction. Our leading industry experience and flexibility allow us to see solutions and possibilities that others miss.

  • Benefits Management

    Plans Designed to Drive a Culture of Health

    Benefits Management

    Our team will help you design and manage programs that drive a culture of health and wellbeing. Consumer Driven Health is one of the key ways to help your organization incentivize a culture of health, by translating benefits and supportive programming into personal engagement and accountability. At HealthSCOPE Benefits, we consider Consumer Driven Health to be not just a benefit plan, but a way of thinking. It provides your company with the tools to keep your bottom line and your member population healthy. We offer a wide range of plans and tools that support your workforce in making value-conscious healthcare decisions that create significant savings for your plan and for them.

    We can help you create, administer and track any combination of benefit designs to drive your culture of health for your total employee population -- retirees, unions, and COBRA.

  • HSB TotalSCOPE

    Care Solutions

    HSB TotalSCOPE

    Our TotalSCOPE Care Solutions provide access to a variety of services and tools that enable innovative approaches to manage the health and wellbeing of your members. These solutions help us actively manage medical trends and improve member compliance. Our proactive medical management program utilizes predictive modeling and Health Advocates to identify members at risk and to steer them into programs that help them manage their health and their conditions. We also provide a full range of “traditional” medical management programs, including pre-certification of inpatient and outpatient services, concurrent review and discharge planning, as well as specialized programs for reviewing high-cost radiology, specialty obstetrics, and mental health services. In addition to these services, case managers serve as advocates, facilitators and educators, assuring member access to quality care at the right time and in the right place. A group of dedicated RNs manages patients who are seriously ill, monitoring services and arranging treatment to help improve overall patient care and reduce plan costs.

  • Claims Management

    Commitment to Claims Payment and Customer Service Excellence

    Claims Management

    Our reputation is built on providing sophisticated, flexible claims administration combined with unparalleled service. We have the experience, the expertise, the technology, and the people to provide superior administration for self-insured plans, from traditional indemnity to the most complex managed care plans and network configurations. We work with you to learn the intricacies of your organization and then tailor an administration program that best fits your needs.

  • Advisory Services

    Bringing the Next Frontier in Healthcare to Life

    Advisory Services

    As one of your most trusted partners, we work around the clock to bring you the most innovative approaches to benefits design and medical management, offering your organization and your members the most value. We have decades of experience creating optimal solutions with the specific needs of our clients in mind. Industry partners want to work with us and we are often one of the first to learn about new ideas. We promise that when there is not an available solution in the marketplace, we will work with you to create one.

  • HSB DataSCOPE™ Analytics

    Accountability. Actionable Data. Timely Reporting.

    HSB DataSCOPE™ Analytics

    HSB DataSCOPE™ Analytics
    We lead the industry in our data warehousing, analytics and reporting capabilities available through our proprietary HSB DataSCOPE™ tool. This information helps our clients understand exactly where their healthcare dollars are going, how this compares to benchmark information, and informs data-driven strategies and solutions. HSB DataSCOPE™ surpasses other information systems in its ability to apply advanced clinical methodologies to healthcare claims data. While other systems monitor only cost and utilization, HSB DataSCOPE™ considers data from a clinical perspective as well, accounting for factors such as age, sex and severity of illness when evaluating plan and provider performance. As a result, clients are able to make more accurate decisions with regard to provider profiling, benefit plan evaluation and management, and other plan management activities. Our latest tool release provides our clients with self-service, web-based reporting access.

  • Network Solutions

    Unsurpassed Network Services

    Network Solutions

    Our Network Solutions team is focused solely on locating or creating the perfect managed care network for your organization. Whether you want the greatest choice or maybe the lowest out-of-pocket costs, we provide solutions that effectively address the needs of both you and your members. This is where we started as a business, and it is why we offer some of the most extensive access anywhere.
    • Access to 140 regional PPOs, as well as additional nationwide and high-performance networks
    • Ability to develop and manage direct contracts and ACO arrangements
    • Unique and specialized network access created for the specific needs of your members; for instance, access to Centers of Excellence at world-class medical providers nationwide

Contact Us

We are proud of our evolution into one of the biggest providers of health care solutions and remain committed to serving self-funded employers with innovative solutions for their complex benefits needs. Let HealthSCOPE Benefits help you build the plan that works best for you!