Underwriting, Assessment and Claims Services
Across the insurance lifecycle—from initial risk assessment to underwriting and claims decisioning—illumifin brings together clinical expertise, purpose-built technology, and operational scale. The result is more data-driven decisions, stronger outcomes, and an elevated experience for carriers and policyholders alike.
Policy and case underwriting
Insurers turn to illumifin for underwriting expertise built on 30 years of industry know-how. In fact, we’re the only third-party administrator serving the long-term care insurance industry that offers in-house underwriting capabilities, and we make an average of 30,000 underwriting decisions annually. Whether we’re supporting new products, managing in-force blocks, or serving as a fully outsourced partner to insurers, we help companies make confident decisions aligned with their risk tolerance.
How we can help
Consultative support
From application intake to final decisions, we can manage the full underwriting lifecycle or integrate into your existing process. Our team understands the nuances of long-term care, critical illness, cancer, chronic illness, Medicare Supplement and hybrid insurance, and can support both complex underwriting and simplified, straight-through processing.
Tech-enabled execution
Our proven operational and technology-driven model results in faster decisions, more consistency, and higher visibility through the underwriting process:
- Automated application intake and rules-based decisioning
- State-specific tele-applications via our assessment services
- Real-time status tracking and updates to the field
- Direct communication of decisions and adverse actions
- Seamless collaboration with carrier requirements
Proven guidelines and methodology
Our proprietary long-term care insurance underwriting guidelines are now in their 16th edition and built on decades of clinical, claims and underwriting data. We can apply third-party criteria, provide ours at no cost, or co-develop guidelines to fit your product goals, pricing, and risk strategy.
Built for your business
illumifin can underwrite an entire product or specific riders, adapting to your structure, workflows and growth goals. We help ensure your business gets the right level of support without added complexity and have successfully underwritten over 1.6M policy applications.
Assessment services
Insurers rely on illumifin for objective, high-quality data to support underwriting and claims decisions. We perform over 120,000 assessments per year to provide a clear view of applicants’ and claimants’ functional and cognitive status—helping carriers manage risk with greater confidence across long-term care, life, hybrid, disability, and supplemental health insurance products.
How we can help
Flexible assessments designed for every need
We meet individuals where they are, with a tailored approach that ensures a seamless experience for carriers and policyholders alike.
- Telephonic, virtual, and in-person assessment modalities
- Standardized or custom scripting and questionnaires
- SMS-based self-scheduling for underwriting applicants
- Nationwide network of thousands of registered nurses across all 50 states and U.S. territories
- Integrative technology that aggregates pharmacy, medical clearinghouse, Medical Information Bureau (MIB) and other third-party information
Deep insight validated by the industry
A highly accurate cognitive assessment is a critical component of successful risk evaluation. illumifin utilizes scientifically proven, industry-leading cognitive screening tools—including the Enhanced Mental Skills Test and Minnesota Cognitive Acuity Screen—to accurately identify the mildest forms of cognitive impairment through severe dementia.
Purpose-built for insurance
Our assessments are designed specifically for insurance use cases, combining decades of industry expertise with modern technology and data integration. We help insurers make faster, critical decisions for applicants and claimants, while our standardized methodologies ensure consistency and alignment with current best practices.
Every assessment is backed by clinical quality review, delivering objective, actionable insights.
Efficient, secure, and specialized
The entire assessment process is completed within a HIPAA-compliant platform, from self-service scheduling to real-time status visibility, reducing administrative burden while improving information security.
illumifin is designated by the State of California as a Care Management Provider Agency (CMPA) and the State of Connecticut as a Care Access Agency (CAA) through its subsidiary, LifePlans, LLC.
Claims management
As the single largest payer of long-term care insurance claims in the industry, illumifin manages over 63,000 active claimants, processes over 1.5 million payment transactions, and handles over $4B in claim payments annually. Over three decades, we have assisted more than 450,000 long-term care insurance claimants through their journey.
And because of this industry leadership, we act as a true partner—not just a claims processor—helping carriers manage operational demands while creating more transparent, empathetic connections with policyholders.
How we can help
We offer end-to-end claims management for long-term care and hybrid insurance products, combining clinical expertise with policy interpretation and advanced workflows to drive accurate, timely and defensible decisions. As a result, insurers improve the policyholder experience while reducing risk and complexity.
Customer-centric, efficient service
Our claims management capabilities bring together modern technology and deep clinical judgment to every decision. We gather and assess comprehensive health information, applying policy language with precision to determine benefit eligibility.
In fact, each claim is managed by a dedicated decision-maker who is always a registered nurse or social worker. This approach brings continuity, accountability and a more thoughtful claim journey to policyholders as well as their caregivers and families.
Scalability for your evolving business
We meet each client’s unique requirements through:
- Flexible integration with carrier workflows for comprehensive claims management
- Rules engines, analytics and workflow automation to accelerate decisions
- Standardized processes, quality controls and escalation protocols
- Ongoing status visibility and communication
- Seamless support for growing or complex claims blocks
Clinically backed accuracy and compliance
But we don’t rely on automation alone. While our technology improves speed and consistency, our licensed healthcare practitioners and policy experts remain central to decision-making. We offer insurers a clinically integrated approach that enables:
- Defensible, policy-aligned claim decisions and payments
- Reduced variability and compliance risk
- Stronger audit and regulatory outcomes
- Faster determinations that improve satisfaction and lower call volumes
Insurance consulting services
Beyond claims, underwriting, and assessment services, illumifin also offers strategy, product, and go-to-market support. Our team can deliver the expertise to move your business forward.
Product development
Compliance consulting
Research and analysis
Claims and Underwriting Audits
Information technology
Marketing and communication support
Get in touch
If you’re a carrier or consultant interested in learning more about our claims, underwriting, and assessment services, reach out to our team.
Policyholders may also direct inquiries to illumifin through this page.
