ClaimSecure

Precision benefits administration for Canadian plan sponsors

Core Administration Established Acquired

Overview

ClaimSecure is a Canadian healthcare benefits administration company with over 40 years of industry experience delivering drug, health, and dental benefit plan administration. Operating under the Canada Life umbrella since its acquisition in July 2021, ClaimSecure serves businesses, unions, and plan administrators across Canada with bilingual support and extended service hours (8am--9pm EST weekdays).

ClaimSecure processes more than 10 million health and dental benefit transactions annually, totaling over CAD 1.3 billion, and serves a client base representing 1.2+ million members and dependants across the public and private sectors. The company combines rigorous adjudication precision with a customer-centric service model, distinguishing itself from larger TPA competitors through hands-on account management.

Products & Services

Falcon Claims Adjudication System

Proprietary comprehensive claims processing engine providing real-time adjudication, advanced analytics, and reporting capabilities. Falcon is the core platform underpinning all of ClaimSecure's benefit administration operations.

Key Features

Real-time health, dental, and drug claim adjudication
Advanced analytics and management reporting
Automated adjudication matrix (first in Canada for communication benefits)

Target Users: Plan administrators, benefit plan sponsors

Administrative Services Only (ASO) Plans

Customized health and dental benefit plan administration allowing employers and unions to self-insure while outsourcing administration and adjudication to ClaimSecure.

Key Features

Fully customizable plan designs
Drug, dental, and extended health coverage administration
Centralized billing and remittance processing

Target Users: Employers, unions, benefit plan sponsors

SecurePak

Combined ASO and pooled benefit product developed in partnership with Canada Life, providing employers a blended approach to self-insurance and risk pooling.

Key Features

ASO administration combined with Canada Life pooling protection
Flexible coverage options for catastrophic and high-cost claims
Integrated with ClaimSecure adjudication platform

Target Users: Employers seeking hybrid risk management solutions

Formulary Protect

Specialty drug cost management program designed to control pharmaceutical benefit expenses while maintaining appropriate member access.

Key Features

Evidence-based formulary management
Specialty drug prior authorization workflows
Cost-containment analytics and reporting

Target Users: Plan sponsors managing high drug utilization

Healthcare & Wellness Spending Accounts

Flexible spending account solutions including healthcare spending accounts (HSA) and wellness/personal spending accounts.

Key Features

Health care spending account administration
Dependent care account support
Integration with primary benefit plans

Target Users: Employers offering flexible benefit designs

Preferred Provider Network Programs

Cost-managed provider access programs connecting members to healthcare practitioners across Canada at negotiated rates.

Key Features

National network of preferred practitioners
Coordinated billing and reimbursement
Member-facing directory and navigation tools

Target Users: Plan members, plan sponsors seeking cost containment

Fraud, Waste and Abuse (FWA) Detection

Analytics-driven compliance monitoring program using proprietary algorithms to identify irregular claim patterns and protect plan integrity.

Key Features

Predictive analytics for claim pattern anomalies
Automated flagging and case management
Customizable reporting for plan sponsors

Target Users: Plan administrators, self-insured employers

eProfile Mobile Application

Member-facing web and mobile platform for benefits management, claims tracking, and healthcare expense monitoring. Includes Canada's only fully automated communication adjudication matrix.

Key Features

Real-time claims status and history
Benefit balance tracking
Healthcare expense submission and management

Target Users: Plan members and dependants

White-Label Solutions

Custom-branded benefit administration solutions enabling advisors and partner organizations to offer ClaimSecure services under their own brand.

Target Users: Insurance advisors, broker networks, affinity groups

At a Glance

Founded: 1982
Headquarters: Mississauga, Ontario, Canada
Employees: 201-500
Funding: Acquired

Category & Focus

Category: Core Administration
Subcategories: Benefits Administration Claims Processing Health Plan Management
Insurance Verticals: Health Group Benefits
Target Customers: Employers, TPAs, Brokers, Agents/Agencies