Awaiting approval
Early warnings >$95K
Premium-weighted
Require reimbursement
In review
$134.5M claims
Incoming reports from TPAs
No submissions yet
Reports will appear here when TPAs submit them
Early warning system for claims exceeding $95K threshold
| Claim ID | Date | Amount | Member | Group | Diagnosis | State | Days | Action |
|---|---|---|---|---|---|---|---|---|
| CLM-2025-089 | 2025-10-08 | $245,000 | HCC-001 | Amera, Inc. plan | Oncology | Adjudicated | 2d | |
| CLM-2025-092 | 2025-10-08 | $122,000 | HCC-008 | Amera, Inc. plan | Transplant | In Inventory | 2d | |
| CLM-2025-091 | 2025-10-07 | $189,500 | HCC-047 | Coastal Retail Group | Cardiac Surgery | In Inventory | 5d | |
| CLM-2025-093 | 2025-10-07 | $115,000 | HCC-012 | Amera, Inc. plan | Neonatal ICU | Adjudicated | 3d | |
| CLM-2025-082 | 2025-10-05 | $134,200 | HCC-015 | Bayview Medical | Neonatal ICU | Adjudicated | 3d | |
| CLM-2025-094 | 2025-10-05 | $108,000 | HCC-019 | Amera, Inc. plan | Spinal Surgery | In Inventory | 4d | |
| CLM-2025-071 | 2025-10-04 | $98,750 | HCC-009 | Phoenix Aerospace | Orthopedic | In Inventory | 7d |
This early warning system alerts you to large claims before they reach the stop-loss reimbursement threshold. Claims shown here are in Inventory or Adjudicated states - these are for monitoring only. You can request supporting documentation proactively to assess potential exposure. Once a claim is formally filed for stop-loss reimbursement, it will appear in the Pending Claims Review section above for your approval.
How close each group is to breaching deductible thresholds
⚠️ Exceeded
⚠️ Exceeded
⚠️ Exceeded
⚠️ Near threshold
⚠️ High utilization
⚠️ Near threshold
⚠️ High utilization
⚠️ Near threshold
⚠️ High utilization
⚠️ Near threshold
⚠️ High utilization
⚠️ Near threshold
⚠️ Near threshold
⚠️ Near threshold
25 groups • 33,945 total lives
Group Name | Lives | Annual Premium | Loss Ratio | Risk Status |
|---|---|---|---|---|
Amera, Inc. plan 550 employees | 1,200 | $7.2M | 🔴 Critical Risk | |
Phoenix Aerospace Systems 840 employees | 1,850 | $11.1M | 🔴 Critical Risk | |
Coastal Retail Group 1200 employees | 2,800 | $16.8M | 🔴 Critical Risk | |
Bayview Medical Associates 480 employees | 1,050 | $6.3M | 🟡 Monitor | |
Summit Financial Group 245 employees | 520 | $3.1M | 🟡 Monitor | |
Gateway Distribution Services 720 employees | 1,580 | $9.5M | 🟡 Monitor | |
Premier Hospitality Group 1500 employees | 3,200 | $19.2M | 🟡 Monitor | |
Midwest Manufacturing Co. 890 employees | 2,100 | $12.6M | 🟡 Monitor | |
NorthStar Energy LLC 520 employees | 1,150 | $6.9M | 🟡 Monitor | |
Silverline Telecommunications 615 employees | 1,320 | $7.9M | 🟡 Monitor | |
Pacific Dental Group 185 employees | 410 | $2.5M | 🟢 Healthy | |
Unity Healthcare Network 1350 employees | 2,950 | $17.7M | 🟢 Healthy | |
Metro Logistics Inc. 650 employees | 1,400 | $8.4M | 🟢 Healthy | |
Precision Manufacturing Co. 1100 employees | 2,450 | $14.7M | 🟢 Healthy | |
Greenfield Construction 425 employees | 950 | $5.7M | 🟢 Healthy | |
Redwood Credit Union 395 employees | 840 | $5.0M | 🟢 Healthy | |
Alpine Technologies Inc. 410 employees | 890 | $5.3M | 🟢 Healthy | |
Advanced Engineering Systems 380 employees | 820 | $4.9M | 🟢 Healthy | |
Frontier Foods LLC 925 employees | 1,980 | $11.9M | 🟢 Healthy | |
TechSolutions LLC 320 employees | 680 | $4.1M | 🟢 Healthy | |
Heritage Insurance Brokers 210 employees | 465 | $2.8M | 🟢 Healthy | |
Cornerstone Consulting Partners 340 employees | 720 | $4.3M | 🟢 Healthy | |
Cascade Realty Group 165 employees | 350 | $2.1M | 🟢 Healthy | |
Valley Healthcare Services 780 employees | 1,650 | $9.9M | 🟢 Healthy | |
Riverside Education Foundation 290 employees | 620 | $3.7M | 🟢 Healthy |
Reimbursement status and processing metrics