Admin

Configuration

Team-wide setup for employer groups, policy years, contract terms, carrier delivery, and filing document rules.

Active policies

Policy records available for setup review

Team members

Owners available in filing queue

Templates

AAW, COB, 50% notice, cover sheet, monthly package

Delivery

10/10

Carrier and HR destinations mapped

New group intake

Minimum setup starts with employer identity, enrollment linkage, HR contact, and one stop-loss contract source.

Employer identity

Common name, legal name, EIN, and group ID.

Required

HR contact

Used for actively-at-work attestations and employer document requests.

Required

Contract source

Upload the reinsurance policy PDF or manually enter policy terms.

Required

Care management vendor

Capture vendor name now; portal integration remains future-state.

Optional

Active policy configuration

A read-only view of group policy setup. Operational reporting and filing statuses live in their workflow pages.

Group	Carrier	Policy period	Spec	Lives	HR email	Case management	Last config update
Amera, Inc. plan Group ID amera-inc	Tokio Marine HCC	Jan 1, 2026 - Dec 31, 2026	$150K	1,200	benefits@amerainc.example	MedWatch	Reviewed Oct 2
TechSolutions LLC Group ID tech-solutions	Sun Life Financial	Jan 1, 2026 - Dec 31, 2026	$125K	680	benefits@techsolutions.example	Cigna UM	Reviewed Oct 9
Midwest Manufacturing Co. Group ID midwest-manufacturing	Berkley Accident & Health	Jan 1, 2026 - Dec 31, 2026	$175K	2,100	benefits@midwestmanufacturing.example	CareGuide	Reviewed Oct 8
Coastal Retail Group Group ID coastal-retail	Voya Financial	Jan 1, 2026 - Dec 31, 2026	$200K	2,800	benefits@coastalretail.example	Not captured	Reviewed Aug 30
Greenfield Construction Group ID greenfield-construction	HM Insurance Group	Jan 1, 2026 - Dec 31, 2026	$150K	950	benefits@greenfieldconstruction.example	MedWatch	Reviewed Sep 30
Valley Healthcare Services Group ID valley-healthcare	Tokio Marine HCC	Jan 1, 2026 - Dec 31, 2026	$150K	1,650	benefits@valleyhealthcare.example	Cigna UM	Reviewed Oct 9
Summit Financial Group Group ID summit-financial	Sun Life Financial	Jan 1, 2026 - Dec 31, 2026	$125K	520	benefits@summitfinancial.example	CareGuide	Reviewed Sep 30
Metro Logistics Inc. Group ID metro-logistics	Berkley Accident & Health	Jan 1, 2026 - Dec 31, 2026	$150K	1,400	benefits@metrologistics.example	Not captured	Reviewed Oct 9
Advanced Engineering Systems Group ID advanced-engineering	Voya Financial	Jan 1, 2026 - Dec 31, 2026	$125K	820	benefits@advancedengineering.example	MedWatch	Reviewed Sep 30
Premier Hospitality Group Group ID premier-hospitality	HM Insurance Group	Jan 1, 2026 - Dec 31, 2026	$200K	3,200	benefits@premierhospitality.example	Cigna UM	Reviewed Oct 8

Clone policy year

Renewal setup should copy the prior year, keep carrier delivery details, and only ask for what changed.

1. Pick prior policy

Use the prior group setup as the source record.

2. Rename year

Create the new policy period without re-entering the employer.

3. Update terms

Change incurred/paid terms, spec deductible, factors, lasers, and attachment.

4. Confirm vendors

Carrier delivery pre-populates; capture case management vendor name only.

Filing document rules

Base filing packet requirements.

Cover sheet

Claim ledger / flat file

Pre-cert

Case management / care notes

COB check form

Actively-at-work attestation

Fee invoices

Carrier filing thresholds

Configured per carrier or policy kit. These thresholds decide when a separate filing record is created once paid claims exceed the applicable specific deductible.

Carrier	Threshold	Source
Berkley Accident & Health	$1,000	Carrier claim kit / policy setup
Sun Life Financial	$500	Carrier claim kit / policy setup
Tokio Marine HCC	$0	Carrier claim kit / policy setup
Voya Financial	$1,000	Carrier claim kit / policy setup

Division access

One unified workspace with mutable division tags. Multi-division users can switch scope; single-division users do not need a selector.

Persona	Role	Visible divisions
Terri Rick	Stop-loss leader	NorthSouthJavelina
Cindi Ward	Team lead	NorthSouthJavelina
Steve Horvath	Executive viewer	NorthSouthJavelina
North rep	Division rep	North
South rep	Division rep	South
Javelina rep	Division rep	Javelina

Data sync and API shape

Normal users should not pull weekly claims manually. The product model is daily sync, member stop-loss context, filing start, then submission.

Daily ingestion

sync Claims, Rx, eligibility, UM, COBRA, and HR feeds

Configured

Shows last sync, ingestion exceptions, and reprocess action for operators. It is not a rep workflow CTA.

Member stop-loss context

GET /stop-loss/member-context?member_id + group_id + policy_year

Needs review

Returns one member's threshold events, 50% notices, filing records, covered periods, documents, and reimbursement status.

Start filing workspace

POST /filing_workspace

Needs review

Creates a separate filing record before submission, fires HR/member document requests, and lets TPA users add UM or care management material.

Submit filing

POST /filing_submission

Configured

Sends the claim ledger flat file and combined PDF packet to the carrier, then tracks reimbursement against that filing.