About Us
History
Products
Self-Funding Administrative Services
Self-Funding Options
Specialty Administration
Property & Casualty
Case Studies
Leadership
2023 Sponsorships
2023 Employee Events
Planned Administrators, Inc. (PAI) is a nationally licensed Third Party Administrator (TPA), delivering flexible solutions across group health plans, ancillary products, and property and casualty (P&C) programs, and offering innovative approaches to support client partners. We currently provide administrative services for both traditional self-funded accounts, as well as providing business process outsourcing solutions for regional and national businesses.
Our mission is to make benefits better by providing affordable and accessible healthcare options, and best-in-class administration to our groups, partners, and entities.
Our vision is to provide opportunities to develop benefit programs that control quality and cost, making it easier for members to get the care they need from the right providers. We accomplish this by partnering with like-minded companies to introduce innovative ideas to the market. Through strong partnerships, PAI will expand our self-funded footprint and specialty administration into new markets.
PAI began in 1981 with a desire to provide unprecedented service and value for self-funded administration of employee benefit plans to South Carolina citizens. Over the years, PAI has evolved into a multi-faceted company with many offerings.
In 1984, PAI became a wholly owned subsidiary of the only South Carolina owned and operated health insurance carrier.
In 2004, PAI started administration of limited benefit medical plans for part-time and hourly employees employed by national and international companies. These fully-insured programs continue to grow today with more than 356,400 members enrolled, and are supported by two carrier partners.
In 2013, PAI became a national administrator for voluntary benefits, including critical illness, accident, and hospital indemnity products.
In 2015, PAI launched Affordable Care Act (ACA)-compliant plans to accommodate large group employer federal mandates. Today, these plans include both self-funded and fully-insured options that help employers meet federal mandates. PAI also acquired Companion TPA, a property and casualty administrator, specializing in workers’ compensation, general liability, and commercial auto.
Today PAI has grown into a nationally licensed TPA authorized to administer business in all 50 states and continues to serve multiple markets. PAI is an industry leader of TPA products, services, and solutions. We’ve built a success story based on a forward thinking vision, a philosophy of collaboration with our client partners, the power of relationships, and innovative benefit administration solutions. Our current product portfolio mix allows us to continue to provide self-funded and fully insured administration for clients as well as incorporate back-room administration for partner carriers.
The business model is simple—we inspire trust and build partnerships by focusing on a benefit design platform that works by:
• Providing flexible administrative solutions.
• Offering unique solutions
• Creating products and offerings that deliver results and resonate value to clients, members, and partners — “Making Benefits Better!”
Every employer is looking for ways to control healthcare costs while providing quality benefits. Self-funding may give you the opportunity to save money on your overall healthcare costs. Market products and partnerships have evolved and now afford almost all employer groups the opportunity to take advantage of self-funding. Start exploring your savings options today.
⊲ Traditional
⊲ Reference-Based Pricing
⊲ Captive Solution
⊲ Level-Funding (PAI Group)
⊲ Dental and Vision Options
Service, Solutions, and Savings
⊲ Superior Network Options
⊲ Preferred Stop Loss Program
⊲ Population Health Management
⊲ Pharmacy Benefit Management
⊲ COBRA Administration
⊲ Employer and Member Portals
⊲ Adjudication
⊲ Eligibility and Auditing
⊲ Billing Services
⊲ Regulatory Assistance
⊲ Subrogation
⊲ Utilization Review
⊲ Case Management
Added Advantages
⊲ Designated Account Executive
⊲ PAI Analytics
⊲ Custom Reporting
⊲ Flexible Benefit Designs
⊲ Superior Customer Experience
⊲ Limited Benefit Medical Plans
⊲ Ancillary and Supplemental Products
- Accident Insurance
- Dental
- Short-Term Disability
- Vision
- Term Life Insurance
- Critical Illness
- Hospital Indemnity
⊲ ACA Plans
⊲ Business Process Outsourcing
Administrative Services
⊲ Workers’ Compensation
⊲ Medical Bill Review
⊲ General Liability
⊲ Commercial Auto
⊲ Commercial Property
⊲ Premium Audit Capability
Cedar Gate Technologies’ Healthcare Benefits Analytics is helping Planned Administrators, Inc. (PAI) better address the needs of brokers, account managers, stakeholders, and client groups, managing over $644 million in billed charges. The self-service analytics software provides streamlined, automated reporting and critical access to member data to help the program – which their users know as PAI Analytics – address rising costs and care quality for their populations.
“With the powerful tools available from Cedar Gate’s Healthcare Benefits Analytics platform, we have seen a significant decrease in the time it takes to provide accurate, timely reports, and an increase in useful data our clients can access through PAI Analytics,” said Kerri Flowers, AVP Self-Funded Operations and Account Management, “Our users can quickly access accurate claim details, uncover meaningful insights that improve care quality, identify opportunities for cost savings, and enhance member experience.”
Since implementing Cedar Gate Technologies’ Healthcare Benefits Analytics platform, PAI has seen a 40 to 50 percent decrease in the volume of ad-hoc requests from customers. End users have access to fully enriched data from multiple sources, all in the same place.
“Before we had Cedar Gate’s analytics software, it could take hours or days for someone at PAI to pull requested data and manually compile it into a shareable report,” said Kartikay Kaushik, Business Analytics Manager, “Now users can do it themselves using PAI Analytics in a matter of minutes, with prebuilt and custom reports.”
“Our Healthcare Benefits Analytics is the most comprehensive analytics tool available today for payers and self-funded employers,” said David Morris, Executive Vice President and Chief Commercial Officer at Cedar Gate Technologies. “The combination of normalized and enriched data with user-friendly analysis and reporting tools is why the nation’s largest brokers, third party administrators, payer ASO divisions, and self-funded employers choose Cedar Gate.”
Cedar Gate’s analytics tools can be used as a standalone application or as part of a composable value-based care platform. Self-funded employers and their partners are under increasing pressure to curb rising costs while still offering competitive benefits. Access to fully enriched member data from dozens of sources that is normalized across an entire IT ecosystem provides a competitive advantage in a data-driven healthcare industry.
Information from disparate data sources is pulled into Cedar Gate’s scalable enterprise data management system. The data is accessible throughout the company’s analytics, care, and payment technology applications. PAI’s clients use the information to make more accurate and timely benefits decisions by uncovering insights unique to their member populations, and using it to identify actionable next steps that improve care and lower costs.
“PAI Analytics also includes Executive Analytics, so brokers have a way to quickly pull together a focused summary of key performance indicators, evaluate against a benchmark of 13 million commercial members, and automate the distribution for stakeholders at every level of their organization,” said Kaushik. “Our users don’t need to continually repeat efforts, which saves so much time. They can run a report for their executive team at whatever time of day or night they need it, and have timely access to see what’s happening with their population.”
In 2023, PAI welcomed a large dental carrier to our book of business. With a quick implementation timeline and stringent carrier requirements, PAI was able to adeptly move all hands on deck to provide streamlined service to the carrier’s 25,000 existing PPO, HMO, and Medicare subscribers.
PAI’s customer service, technology, claims, and account management teams pulled together to make benefits better for the carrier, dental providers, and their members.
PAI’s customer service team was quickly able to adjust staffing and expand call center hours to accommodate West Coast dental providers and members without any compromise in service.
Each month, PAI’s dedicated customer service team has met or exceeded the following performance standards:
• Average speed of answer (ASA) less than 30 seconds.
• Abandon rate of less than 4%.
• First call resolution – 95% of calls are resolved on the first call.
• 98% of calls are closed within five business days with 100% of calls closed within 10 business days.
PAI’s partnership with an industry leader in providing dental claim review services has proved to be integral in the dental carrier’s extensive pre-authorization requirements. Each month, PAI has been able to deliver timely service for pre-authorizations:
• More than 98% of pre-authorization requests received are processed within 14 days for non-emergencies.
• For emergencies, more than 98% of expedited pre-authorization requests are processed within 72 hours.
PAI created a customized claims handling and eligibility intake approach to support the carrier’s compliance requirements. A separate claims system was implemented to segregate data and expand on dental claims processing needs.
PAI’s IT team was able to identify and accommodate complex eligibility data presented by the carrier to minimize any disruption to new and existing members.
PAI’s web-based user portal has given providers, members, and employers access to information 24/7. Members are able to email customer service, print or request an ID card on demand, find a network provider, review claims, and access forms.
The claims team has also taken a personalized approach by using a dedicated group of processors for the carriers to meet expedited timelines. Each member has more than 15 years’ of experience in the industry to ensure claims are paid correctly and in a timely manner. PAI is committed to meeting the following standards:
• Greater than 92% of clean claims processed in 14 calendar days.
• Greater than 95% of all claims processed in 30 calendar days and 100% of all claims processed in 60 calendar days.
With a dedicated IT Project Manager and a dedicated Account Manager, PAI has been able to ensure all teams are effectively communicating and continuously striving to provide the best service possible. This customized approach and personalized touch is one way PAI makes benefits better.
George Stiles is President and Chief Operating Officer of Planned Administrators, Inc. (PAI). As President, Mr. Stiles leads all aspects of sales, strategy, finance and operations for PAI’s multiple lines of administrative business. He joined PAI in September 2006 and has over 25 years of experience with our parent company, where he served in various management positions. He is a graduate of the University of North Carolina at Chapel Hill and has his MBA from Southern Wesleyan University. Mr. Stiles is a member of the Leadership Columbia’s class of 2007.
Amanda Gantt joined PAI in December 2012, serving in a variety of management positions leading up to her most current. She oversees the finance and accounting functions for our fully-insured and selffunded business. She also oversees our compliance and quality assurance area. Prior to joining PAI, she held various auditing roles with the largest health insurer in South Carolina for 15 years. She is a graduate of the University of South Carolina and is a Certified Internal Auditor.
Scot Dawkins oversees computer operations, programming, telecommunications, and system support. A graduate of Winthrop University, Mr. Dawkins has been with PAI since 1994. He is also certified in several areas of IBM system administration.
PJ Rescigno joined PAI in April 2007 and oversees the specialty product functions, delivering products and administrative solutions to the market, and leading business development efforts for PAI. He graduated with a B.S. degree from Winthrop University. Prior to joining PAI, he was Managing Director of the southeast region of a multibillion dollar specialty chemical company and an Executive Search Consultant with a privately held employment search firm.
Kerri Flowers oversees enrollment, claims processing, customer service, and account management for the self-funded line of business. She joined PAI in 1999 and has served in various management positions. Prior to joining PAI, she was with the largest health insurer in South Carolina for six years. She is a licensed agent in life and health insurance, has a Professional Academy for Healthcare Management (PAHM) designation, and is a graduate of the University of South Carolina.
Suzanne Miller oversees all compliance activities, quality assurance, training, and HIPAA Privacy. She has been managing in a healthcare environment since 2000 and has been with PAI since 1996. Prior to joining PAI, she was with the largest health insurer in South Carolina for five years. She is a registered nurse (RN) with a Bachelor’s Degree from South University and has also attained the designation of Fellow of the Life Management Institute (FLMI).
Before being named Director of Sales and Stop Loss, Tim was the Senior Director of Mid and Large Market Sales and Account Management at UPMC Health Plan in Pittsburgh, PA. Tim has been in the industry for 25 years, and has led both health insurance carrier and broker sales teams. He obtained his M.B.A. from Robert Morris University in 1997.
Tosca Walls oversees operations, administration, and claims processing for the Property & Casualty line of business. Prior to joining PAI in 2015, she served in various management positions for ten years with the largest health insurer in South Carolina. Tosca is a graduate of Austin Peay State University and has also attained Associate in Claims (AIC) and Associate in Insurance Services (AIS) designations.
PAI is proud to support our local community through various sponsorships:
⊲ American Staffing Association
⊲ Alliance of Women in Workers’ Compensation’s Tidings and Tinsels Event
⊲ Families Helping Families
⊲ United Way of Midlands (SC)
⊲ The Salvation Army
⊲ Junior Achievement of Greater SC
⊲ United Way of Midlands (SC) and Women in Philanthropy’s “Power of the Purse” Event
