16 Threshold Rules Routed in Real Time
Know the moment a deductible crosses 50% — not when the carrier's report arrives next quarter.
RiskFlow ships 16 pre-built alert types that fire automatically as claims land: specific deductible thresholds (50 / 75 / 90 / 100%), aggregate corridor burn at 70 / 85 / 95 / 100%, claim velocity spikes, repeat ER visits, new cancer diagnoses, specialty med starts, dialysis progression, repeat inpatient stays, and pharmacy spend trends. Every alert is assigned, due-dated, and tracked to resolution.
Alerts fire at four specific deductible checkpoints — 50%, 75%, 90%, and 100% — for both per-claimant specific and aggregate corridor exposure.
Sudden claim spikes, repeat ER, repeat inpatient, and dialysis progression alerts route to the clinical intervention team within minutes.
Each alert carries an owner, a due date, an estimated financial exposure, and a recommended intervention — no orphan alerts.
New → Acknowledged → In Progress → Resolved / Dismissed with resolution notes. Historical alert log drives audit and renewals narrative.
Every new claim is evaluated against the 16 active alert rules and the employer's specific and aggregate deductible position.
Exposure, owner, due date, and recommended intervention are computed and posted to the dashboard.
Alert owner acknowledges, records an intervention, and updates status through to resolution.
Closed alerts and their resolution notes feed the renewal narrative AI and executive reporting.
“Our 75% deductible alert on a trucking client gave us 90 days to negotiate, and we shaved 14% off the renewal.”