Every claim sits in a queue until someone works it. When the queue grows faster than the team, payments slow down and preventable errors reach the payer. Connext builds the dedicated claims team that keeps that queue moving.
Quick answer
Working every claim from intake to payment, denial or close, and clearing whatever stops it on the way.
A claims management team takes a claim from the moment it arrives to the moment it is paid, denied or closed. The team confirms coverage, checks that the documentation is complete, applies the plan rules, resolves the errors that would hold the claim up, and follows up until there is a decision.
Most of that work is not the decision itself. It is the preparation and the follow-up around it: verifying eligibility, chasing a missing authorization number, correcting a code, checking status, and reworking what comes back denied.
Connext Claims Teams are dedicated claims specialists who do this work all day, inside your system and under your rules.
Connext does not take the queue away from you. Connext builds the team that works it, and you keep deciding how it runs.
Who finds the people?
We do. Connext recruits against your volumes, your payers and your platform, not against a generic claims profile.
Who employs them?
Connext does. We are the legal employer in-country and handle contracts, payroll, benefits and local compliance.
Whose systems do they work in?
Yours. The team works inside your claims platform and your workflows, under your access controls.
Who owns performance?
An operations manager at Connext. They run weekly reviews, track accuracy and turnaround, and manage retention.
01
Intake and data capture
Records the claim and its supporting documentation accurately the moment it arrives.
02
Eligibility and coverage verification
Confirms the patient is covered and the service is payable before the claim goes out.
03
Claim review and edits
Researches and clears pre-processing errors so the claim is filed on time and clean on the first pass.
04
Denials and appeals
Corrects denied claims, resubmits them and works the appeal to each payer's requirements.
05
Status follow-up and reporting
Checks claim status, resolves discrepancies and reports where the open inventory stands.
The backlog is the visible part. The expensive part is what happens to accuracy while the backlog grows.
Deloitte found that insurers with high adjuster turnover saw operational costs rise by roughly 12%, and that those relying on underprepared staff reported up to 20% higher indemnity payouts. McKinsey describes the same pattern from the other side: manual steps and legacy systems slow claims down, push operating costs up and wear down the customer relationship.
On the provider side, 75% of healthcare organizations still run at least part of the revenue cycle on paper. None of that is solved by buying software in a quarter. It is a capacity problem.
You do. Outsourcing changes who works the claim. It does not change who the regulator, the payer and the patient hold responsible for how it was handled.
That is why the controls below belong in the agreement before the first claim is worked, not added after something goes wrong. Connext sets them up at the start: the team is yours, the authority stays with you, and there is a record that proves it.
An authority matrix says so, in writing. Every role carries a documented limit, and nothing outside it moves without you.
In the system, not in a manual. Approval limits only hold when they are enforced at the platform level.
Yes, on a set cadence. Audit rights, quality sampling and performance reporting work best as one connected record.
It follows a named path with a clock on it. Escalation protocols and continuity plans are agreed before launch.
Connext writes these four controls into the agreement before the first claim is worked, and your operations manager reports against them every week.
Scope your first queueAlmost nobody starts with the whole cycle. Most clients hand over one queue, prove the accuracy on it, and grow from there.
Do you start with the backlog?
Often, yes. Aged inventory is the easiest place to show accuracy and turnaround without touching live workflows.
Can you take only denials?
Yes. Denials and appeals is the most common first queue, because the work is defined and the result is measurable.
What about intake?
Intake and data capture is the other common entry point: high volume, clear rules, and the place where most downstream errors are born.
What if volume spikes?
Enrollment periods and surges are covered with dedicated reserve capacity rather than temporary hires.
Who decides the claim?
You do.
The determination itself, pay, deny or ask for more, stays with your organization.
Who sets what you reserve?
You do.
What a claim is likely to cost, and what you hold against it, stays an internal decision.
Who answers a complaint?
You do.
Anything that carries a regulatory reporting duty stays in-house, with your name on the response.
Who refers fraud and decides to litigate?
You do.
Fraud referral and litigation authority stay inside the entity that answers for them.
Send a job description and Connext takes it from there.
01
Assess
Defines the workload and identifies the roles that have to be filled first.
02
Recruit
Presents pre-screened candidates measured against your own requirements.
03
Train
Aligns the team with your plan documents, your systems and your policies.
04
Evaluate
Runs quality audits, feedback loops and the KPIs you agreed on.
05
Execute
Full production, with the operations manager staying on the account.
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