Looking Back: 10th Anniversary

I’m going to deviate from our typical Industry Perspective and get personal by sharing more details about our company and myself than I’m typically comfortable doing. January marks our 10th anniversary, and the achievement has struck me differently than I expected. I rarely stop to reflect on what we’ve accomplished. I have never been satisfied with my work, and I’ve surrounded myself with leaders at ClaimDOC who operate with this same drive to demand more and be better. It’s time to be proud of what we have done and share our story.

Anyone that has built a business from nothing and with nothing will understand how complex my life has been over the last 10 years. It all started when a captive program I had with partners was decimated in 2012 by high-cost claimants. Through hands-on bill review work, I saw firsthand the abuses in the billing and flaws in network contracts. I then learned RBP solutions didn’t adequately take care of members. This is when and why I started ClaimDOC as a full-service network replacement option for plan sponsors.

Like many people willing to risk their family’s financial future to start a business, I admit I have a unique and probably challenging personality. Externally people will see success, but what they don’t see are the times when you almost break mentally and financially. Like many flawed people, this has sometimes brought out the worst in me, creating a line of people who deserve an apology. I’m very lucky my leadership team at ClaimDOC is willing to hold me accountable, show me compassion, and push me to be better. Two executives, Amy Pellegrin and Bruce Hansen, joined me in 2016. Not only have they been the key to my company turning the corner, more importantly, they have cared about me as a person. Beyond friendship, we’ve shared a vision to not make this about our personal finances and instead drive investment into our people and solution to quietly build ourselves into a powerhouse.

I don’t know if I would wish this on anyone, but the journey has been amazing. Growing from 5 to 20 to 50 and now housing over 100 employees in our custom renovated 30,000 square foot headquarters. Seven years ago, we had two amazingly talented young people, Steph Mohr and Sam Apland, join us. Since then, they have put their heart and soul into my dream. Their trust in me and seeing them develop into the best in the business at what they do gives me a feeling I can’t explain. Going from developing raw talent to having seasoned industry experts like Omar Arif, Brad Hansen, and Cynthia Swanson see what we are doing, and wanting to be part of ClaimDOC is very humbling.

Along with building relationships, seeing the impact of the success of our program throughout the journey has been extremely rewarding.  Watching clients clean up their financials to both stabilize and then redirect capital into sources of growth always strikes a chord with me as a fellow business owner. More than anything, hearing about clients enriching benefits and reducing premiums is the best part of my journey. There is an immeasurable satisfaction knowing the program I started 10 years ago is meaningfully making a financial difference in the lives of the average worker trying to provide for a family. 

When we hire new sales reps, they always want to know about our reputation in the market. I usually tell them they will probably meet people who don’t like me, but you’ll be hard-pressed to find anyone with something bad to say about ClaimDOC. In a niche that is hard to make people happy, we consistently hear, “it’s really weird, but everyone has nothing but good things to say about ClaimDOC.”  Our effort to take care of clients instead of creating misleading product variations to draw in clients that may not be ready for network replacement has paid off. In 10 years, our retention rate has never dipped below 85%, with most years being over 90%. The value we have placed on member experience and client satisfaction has earned us a reputation that is creating a snowball effect our sales team is taking advantage of.

In contemplating 2022, from a business perspective at ClaimDOC, two words continue to jump to the forefront: Blessed and Optimistic.

We are blessed to work with an extensive list of high-quality trading partners, including employee benefits brokers, consultants, account managers, TPAs, PBMs, pre-cert vendors, and stop loss carriers. The true spirit of partnership is something we value highly. We’ve been fortunate to find the right people and firms to work with who understand the intricacies of network replacement and see the value of using ClaimDOC as a long-term strategy. I think it’s purely a coincidence, but I turned over sales leadership to Omar Arif a year ago, and we saw new and improved relationships with distribution channels. I think it’s because our competitors are letting people down, but Omar thinks he is just more likable. Either way, many of these relationships are just beginning, and I’m very optimistic they will blossom into increased sales.

Although we haven’t entirely seen the fruits of our sales labor, during the sales cycle covering 2/1/22 to 1/1/23 we achieved comfortable growth with 78 new clients. Some relationship items of note:

  • TPA Relationships – We wrote new business with 19 different TPAs. A handful of these were new TPA relationships, and we continue to shine with our talent and system flexibility. It was noted by several new TPAs that we are by far the most detailed and sophisticated RBP vendor when it comes to 837 claims exchange.
  • Broker Relationships – We wrote new business with 45 different brokers/consultants across 33 different firms. We have an extremely active sales team looking for the right partners. Reflective of the growing acceptance of network replacement, we grew our presence in the large firm space by selling cases with the following:
    • USI
    • Marsh
    • Brown & Brown
    • OneDigital
    • HUB
    • Alliant

But as an old dog in this game, I remain reluctantly optimistic on these channels and will always have a soft spot for the independents. We met and developed relationships with some fantastic and thoughtful consultants in 2022. They are the backbone of what we do, and without these advisors, ClaimDOC wouldn’t exist. I always get asked why RBP isn’t bigger than it is and it’s very simple, reluctant brokers. The willingness to not just sell a case, but to believe and stand behind the process is incredibly commendable. I will also take this opportunity to thank David Contorno and Emma Fox at E-Powered for being our highest producers in terms of the number of new clients (not lives). We don’t always see eye-to-eye, however, we have mutual respect in our efforts to deliver the best possible solution for clients.

Looking ahead, we will do what we always do, seek out ways to improve our comprehensive service model and make the health plans we partner with operate with more efficiency and effectiveness. I can’t imagine having a board talking to me about squeezing clients and enhancing profitability. Yes, our program is not cheap, and we must ensure clients are charged appropriately. However, the goal is to focus investment on innovation and enhancements to improve the client and member experience. To maintain this financial model, we inherently have to be thoughtful about gaining efficiencies of scale as we grow. Said differently, our mission dictates the efficiencies of scale create more investment in our clients, not greater profitability to investors.

The ecosystem our employees operate within to process claims and service members efficiently is mind-blowing compared to four or five years ago. We aren’t done and will continue to work tirelessly to improve every aspect network replacement demands. The most externally visible elements will be enhancements to Pave the Way® and the entire member experience. Client satisfaction demands will evolve with the always-changing hurdles intentionally created by the establishment that wants network replacement to go away. The most prominent enhancement will be around member tools. We have developed and beta-tested technology for the last couple of years to provide services for those interested in self-help options. Nothing can replace the value of human interaction in managing access for a network replacement solution. While I haven’t always been supportive of this new self-help option, I know exploring new ideas is necessary for us to evolve. I believe despite delivering an unmatched experience, we have just scratched the surface on an exceptional network-free experience for a member.

We have been sharpened by 10 years of focus on servicing clients and members that have used ClaimDOC to replace their network. We have the expertise gained from over 1 million claims processed and over $1 billion in billed charges ($334,523,641 in allowed for those scoring at home). Situational awareness from experience is our most valuable asset and deploying that knowledge is our strength. Every claim is processed outside of a network setting with no guarantees on anything other than a promise to take care of the member and the client. It works and I’m very thankful for every single employee that has made it work and every single distribution partner that trusted it would work. I’ll continue to work on being a better person, while promising to keep that edge that has helped shape the attitude and energy of our entire company. We aren’t right for everyone, but we are for those that want it done right.