TRIBAL RISK SOLUTIONS
It takes creativity and a willingness to embrace unconventional approaches to prosper amid the storms of our ever-changing economic climate.
Profit Finders has partnered with Paragon Risk Management Services to bring a platform of innovative risk management solutions. This collaboration is ‘Tribal Risk Solutions”.
Tribal Risk Solutions was designed to target the inefficiencies that are found in most large insurance programs but with special reverence to the unique issues that face tribal populations. Whether a tribe is in the traditional insurance marketplace, partially self-insured, or fully self-insured, Tribal Risk Solutions will identify strategic areas in which the overall spend in a program can be reduced. Rather than merely seeking out discounts or topical savings, Tribal
Risk Solutions evokes meaningful change at the level of the core disciplines that affect claims, pricing, and overall results. Learn more about Profit Finders here.
Tribal Risk Solutions offers consulting for all lines of coverage:
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Healthcare Coverage
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Property & Casualty
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Commercial Lines
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Employee / Tribal Member Benefits
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Workers Compensation
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Captives and Alternative Risk Solutions
There are 7 core disciplines that affect health insurance programs:
Claims Management / Processing
Proper claims administration is the foundation of an effective insurance program. Tribal Risk Solutions contracts with best-in-class Third Party Administrators with the experience and resources to manage the standard claims process as well as handle highly complex or unusual claims.
Pharmaceutical Benefit Management
Prescription drug benefits are a major cost component of any health plan where misuse and inefficiencies can be eliminated to produce significant savings. Tribal Risk Solutions employs cost justification modeling, cost containment strategies, and reporting tools to
provide sound RX administration in support of healthcare objectives.
Network Design
interests of payer groups and healthcare providers are often at odds. We believe this need not be the case because both want the best possible health outcomes for the people they serve. Tribal Risk Solutions helps payer groups access or develop a provider network
that employs an accountable care methodology to deliver top-quality healthcare in the most affordable way.
Reinsurance / Stop Loss
Stop Loss insurance protects a self-funded program from catastrophic or unpredictable losses. Coverage can be purchased to limit the program’s liability arising from a specific large claim or the aggregate of claims that occur throughout the year. Tribal Risk Solutions works directly with top-rated Stop Loss carriers to obtain the coverage that strikes the right balance of risk assumption and premium cost for your program.
Case Management / Complex Care
Patients receive compassionate and expert care coordination from advanced practitioners and nursing staff to help them manage major health conditions such as diabetes. Tribal Risk Solutions offers direct integration between the medical management and utilization review
components of a self-funded health plan to ensure that complex care needs are met with proper coordination of the network’s resources.
Population Management
Tribal Risk Solutions deploys population management programs with proactive strategies and interventions that improve the health of individuals at the lowest necessary cost. Maximum health results and lasting change are achieved though integrated case management, health coaching, centers of excellence, disease management, and powerful analytics.
Risk Management
Rather than just requesting discounts from the traditional insurance marketplace, Tribal Risk Solutions evaluates the risks facing an organization and designs solutions to manage the financial impact of potential losses. We work with you to identify, analyze, and finance loss exposures in the most cost-effective manner.