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Quality assurance

Image - This is our commitment to you

Two of our main priorities are quality and ongoing improvement.

Our quality assurance program is based on best industry practices and ensures we are consistent company wide. The program deals with everything from training to employee coaching, quality standards and service indicators.

We're always striving to achieve the highest quality standards. You can count on us to provide the following:

  • Claims audits

    • Thanks to our quality assurance program, claims for drugs and medical, paramedical and dental expenses are processed accurately.

      The program includes:

      • Quality assurance technicians assigned to work with teams of claims examiners
      • Daily audits of processed claims
      • Pre-authorization of expensive treatments
      • Integrated automatic controls

      Electronic claims processing is also monitored by automated controls that are integrated with the systems of our service provider, ESI Canada.

  • Fraud prevention
    • Group insurance fraud and abuse result in financial losses that can lead to higher premiums. 

      That is why preventing fraud and abuse is a key part of our quality assurance program. Our program includes:

      • A fraud and abuse detection team
      • Abuse detection systems
      • A list of questionable providers and professionals
      • Daily audits of a sample of processed claims

       We also have a confidential and anonymous service that insureds can use to report suspected abuse or fraud.

       To report suspected fraud or abuse:

      Call 1-866-692‑7227

      or send us an email.
  • Customer service

    • An expert team to help set up your plan

      For larger companies, setting up a plan often involves a lot of communications and cooperation in a short period of time. That is why we have dedicated teams to work with you throughout the process to get the job done on time. The cornerstones of those teams are the implementation coordinators, whose role is to coordinate the efforts of everyone involved to make sure the process runs as smoothly and efficiently as possible.
      These efforts can include:

      • Working groups
      • Weekly calls
      • Print materials

      An answer on the first call

      Our Customer Contact Centre agents answer over 4,000 calls every day. Their goal is to answer your questions the first time you call.

      Our call centre agents are selected for their experience and knowledge of both insurance and customer service. They are actively supervised and receive ongoing training.

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