A deep dive into the process of forensic claims analysis, from identifying compensable causes to managing recoveries from statutory bodies
Retrospective recovery is a powerful tool in the arsenal of any healthcare funder serious about financial integrity. It starts with a deep dive into years of claims data, uncovering instances where expenses were linked to workplace injuries, third-party liability, or other compensable events. These claims should never have been absorbed by a medical scheme or employer.
At Risk Work, we use a unique blend of data science, clinical acumen, and regulatory expertise to detect these anomalies. Our proprietary tools map diagnosis codes to potential liability causes, allowing us to accurately flag claims that can be pursued for recovery. But it doesn’t stop at detection—we manage the entire recovery lifecycle, from documentation to submission and negotiation.
The impact of this service is tangible: recovered funds, improved risk pools, and tighter financial controls. For organizations with thousands of historical claims, the potential recovery value is often in the millions. Retrospective recovery is not just an operational process—it’s a strategic advantage