The client (public sector organizations) provides MMRO with a disability claim application for their members describing the disability that is under consideration. Medical records are submitted with the application and additional data is gathered during the claim review process. When needed, a network of internal physician specialists can be called upon to refer the individual for additional medical analysis. This medical team contributes to the clinical recommendation back the client regarding the eligibility on the validity of the disability claim.
Technology from the Beginning
From the beginning, MMRO recognized that technology was the key to effectively managing their claims application, review and recommendation process. In the early years, MMRO had an Oracle based system that, along with some manual processes, was manageable for their existing client base. As their business started to experience more growth, the legacy
Oracle platform was unable to grow with them. With limitations to the expansion of data fields and workflows their system could not scale and MMRO could no longer effectively operate with this system. MMRO also needed to address their manual processes and ensure they would be automated to facilitate the increased workload.
They evaluated a number of possible CRM systems and chose Dynamics CRM Online and TM Group
, a local CRM partner to configure a Claims System. The TM Group recommended The Portal Connector to manage the Claims Process through a secure portal.