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GxClaims™: Benefit Load Certification, Claims Generation and Claims Testing

GxClaims™ is a demographic and clinical selection, benefit plan certification, claim adjudication analysis, and integrated defect tracking process designed to validate claims processing behavior and increase efficiency in identifying root cause for unexpected claims adjudication outcomes.

Key features of GxClaims™ include:

  • Define, test, and validate claim behavior within an adjudication system for demographic and/or clinical scenarios
  • Augment targeted scenarios with randomly selected claims data providing for breadth and depth of testing
  • Compare and analyze claim outcomes across source and target benefit plans or adjudication systems
  • Integrate claim analysis with benefit plan configuration Profile claim outcomes with bulk tagging and tracking capability

Points of value:

  • Increased predictability of pricing performance
  • Reduce your business exposure and SME hours
  • Increase issue resolution and client satisfaction


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