COMPLEX & CATASTROPHIC CASE MANAGEMENT SUITE
Proactive Recovery for Your Most Critical Claims.
Complexity, controlled.
Transform complex and catastrophic claims from reactive handling to proactive recovery. Identify high-risk cases sooner, steer claimants into specialized pathways, and elevate case manager performance—reducing duration and cost while improving outcomes.
Complex and catastrophic claims often suffer from "rear-view mirror" management—where action is taken only after costs have spiraled.
Arthur Health shifts the timeline. By combining deep clinical expertise with CareNexus Insights, we isolate anomalies in care delivery and flag high-risk patterns early. This gives claims leaders the actionable signals they need to intervene sooner, steer claimants into specialized pathways, and prevent duration from slipping out of control.
Identify risk before cost
Drive proactive intervention
Reduce duration and spend
THE ARTHUR HEALTH ADVANTAGE
From Reactive Handling to Proactive Control with Purpose-Built Solutions
Managing high-severity claims requires more than standard workflows. It demands a specialized ecosystem where clinical expertise meets predictive intelligence to stay ahead of risk.
Risk, stratified. Spot the cases most likely to become complex before costs spiral. Segment claims by severity and intervention level (no‑touch, low‑touch, high‑touch), then automate smart routing into the appropriate level of care.
Pathways, specialized. Deploy ready‑made clinical models for catastrophic injuries—from amputations to neurological trauma, mental health, complex extremity, and spine. These pathways are built for rapid activation within insurer workflows.
Expertise, steered. Stop relying on generalists for specialists' work. Identify and partner with high‑performing providers, using performance analytics to steer complex claimants to teams that deliver faster functional recovery.
Performance, coached. Measure the impact of adjuster actions on recovery, closure time, and spend. Normalize for complexity, surface best practices, and embed a coaching playbook to drive consistent excellence across catastrophic teams.
Leakage, stopped. See treatment patterns and care intensity across the continuum. Pinpoint over‑medicalization, billing leakage, or gaps in care—and course‑correct immediately with pathway and provider adjustments.
Integrity, protected. Detect outliers in billing, frequency, and provider behavior. Our system highlights fraud signals and anomaly detection to reduce misuse, protecting both your bottom line and the claimant’s care integrity.
The result is a closed-loop system where no high-risk claim falls through the cracks. You gain control over leakage and duration, while the claimant receives the specialized care they need to return to life.
