Company Profile
ArgusFirst is a unique company formed by insurance industry leading experts consolidating our expertise into where the largest impact can be made on overall claim file exposure. As a truly full-service multi-line investigative company, our largest impact for our clients is provider fraud and abuse.
To tackle the largest claim cost drivers (Medical), our comprehensive approach includes proactive front-end strategies beginning with Bill Review. We also integrate investigations to help our clients better manage a claim file rather than process them. Once the case in chief is settled, our back-end lien defense provides industry leading savings and bulk resolutions. When you have the experts with decades of provider fraud experience, who else would you rather help negotiate liens?
Our experience in investigating over a thousand providers, conducting bulk settlements, resulted in over $50 million in real savings across thousands of claim files. Our filing of lien consolidations outlining fraud and abuse by providers, testifying before grand juries and in criminal/civil trials has created a unique set of knowledge, no other company has, compiled into a proprietary database.
In addition to provider fraud, our expertise extends well into all facets of a full-service Special Investigations Unit (SIU). With hundreds of claimant and premium fraud convictions, our experts can take the toughest fraud cases to law enforcement with a high percentage of success. Our national carrier experience developed, wrote and submitted anti-fraud procedures, mandated reporting and annual SIU compliance filings across the nation.
Our SIU experience and oversight on claim investigations results in better investigations are designed to help our client better manage a claim file. Statement and Surveillance assignments are driven by an SIU perspective. Comprehensive backgrounds and social media scrubbing are conducted by staff who are specifically trained by an ex-FBI expert in open source intelligence. Medical canvasses cover larger geographical areas than our competitor’s product.
Our program affords clients the flexibility in unbundled services. Clients may choose what service, or services, that best fits their needs. Our passion to multifaceted investigative services aligned us with law enforcement, government agencies, insurance carriers and employers.
Focusing on the claims costs of our clients, we provide affordable and efficient solutions that result in accelerating claim closures and relieving the negative pressures on the combined ratio in multiple facets…(ULAE, ALAE, MED). Having claims examiners better manage their claim file rather than process them, means smarter, effective and lower overall claim costs.
