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Seventeen years ago, Omar Arif stepped into an employee benefits industry already grappling with the soaring cost of healthcare. Back then, health savings accounts and health reimbursement arrangements were emerging as popular tools to help health plan members manage expenses. “The same problem still exists today,” Arif, senior vice president of growth at ClaimDOC, says. “The difference is that now there is a compelling alternative that allows employers to offer richer benefits at a lower cost to their employees. They just need to keep an open mind.”
Blue Cross Blue Shield, United Healthcare, Cigna, and Aetna—commonly referred to as BUCAs—have a stranglehold on the employer-sponsored insurance market. Companies that are seeking to lower their healthcare costs and continue to turn to the BUCAs will never realize any savings, according to Arif. “If you’re moving your plan from year to year to save maybe 3 percent, you’re on the same hamster wheel. It’s just going to keep happening to you every year, renewal after renewal,” Arif says.
More recently, companies in need of substantial savings on their health benefits have been turning to less conventional strategies, such as reference-based pricing (RBP). RBP is a type of medical claim pricing utilized by self-insured medical plans that uses Medicare rates to establish a consistent reference point. Traditional programs rely on a carrier or network with provider contracts. The lack of reference point consistency and outlier provisions with these plans make it impossible to understand the cost of services or value of a discount. With Medicare rates as the consistent reference point, RBP transparently lowers the high costs of healthcare.
ClaimDOC, a national medical claim auditing and member advocacy company, delivers successful and sustainable self-funded medical plans to companies and their employees. Using a modern RBP solution called DirectAccess+®, ClaimDOC promises savings of up to 33 percent in the first year after a switch between plans. “The annual plan trend is somewhere between a 6 and 12 percent increase,” Arif says. Not only does ClaimDOC promise savings in the first year, but it flattens costs year over year.
“We can give a company’s population lower plan deductibles and lower payroll contributions. It’s a win for everybody,” Arif says. Although not a traditional health insurance plan, ClaimDOC offers its plan members an enhanced level of benefit. “It’s just an easier way to go about it,” Arif points out.
Direct Access+ is designed to replace traditional PPO networks with a more transparent, cost-effective and member-focused healthcare experience. It combines rigorous claim auditing, proactive provider engagement and legal protections to deliver a comprehensive cost-containment solution.
Prior to open enrollment, ClaimDOC’s Pave the Way® program helps members coordinate their upcoming care with their current physicians. Before a plan even goes live, member advocates reach out to providers to explain how the plan works, confirm their willingness to accept it and address any concerns. This early outreach builds trust, reduces friction at the point of care, and helps members avoid surprise billing or provider confusion. “We make sure plan members in our program have direct access to the provider of their choice,” Arif explains.
Pave the Way dramatically improves provider acceptance rates and ensures a smoother, more confident experience for members navigating a nontraditional health plan. If the company is transitioning from a Blue Cross Blue Shield (BCBS) plan, for example, and the plan member and their dependents are seeing six different doctors, ClaimDOC’s team will contact each of those six practices to advise them that the patients are rolling off BCBS and make sure the practices accept ClaimDOC’s program.
“The doctors are highly receptive and appreciate the proactive outreach,” Arif says. “When we educated them and went through the Pave the Way process, we got a 94 percent acceptance rate in 2023, a 96 percent acceptance rate in 2024, and we have maintained that 96 percent acceptance rate in 2025.”
Switching to a new health plan is not without its challenges. While Pave the Way addresses the access-to-care issue, buy-in can still be difficult, especially for employees who’ve been carrying BCBS PPO ID cards in their wallets for the past ten years. “Now you’re giving them a card that says ClaimDOC, that they may or may not have ever heard of,” Arif says. ClaimDOC alleviates member anxiety through its member advocacy. Each member receives a dedicated member advocate, who helps walk them through the plan. The member advocates are trained to deliver a concierge-level experience that prioritizes transparency, support and proactive care.
“We can give a company’s population lower plan deductibles and lower payroll contributions. It’s a win for everybody.”
Omar Arif
ClaimDOC’s implementation team begins the transition process anywhere from thirty to ninety days ahead of the company’s open enrollment period and the switch. Its client services and sales teams provide detailed communications throughout the process to each client, helping them navigate obstacles and better understand how the plan works. “We have dedicated implementation managers that quarterback the transition process, making sure we’re aligned with the leadership team,” Arif shares. “All the communication pieces are put out to the population and are client-branded.”
ClaimDOC’s marketing department customizes educational flyers and videos, and the implementation team hosts virtual presentations geared to plan members and their dependents. “They even go on-site and help with group meetings. Whatever the client likes to do to educate their people around benefits, we’re there to support that initiative,” Arif says.
Arif joined ClaimDOC in 2020 with extensive knowledge in healthcare cost containment strategies like RBP. He leads a sales team of ten, including seven vice presidents of business development. While his sales team has driven the company’s growth, he credits ClaimDOC’s entire solution for sustaining it. “You can sell all you want, but if you don’t service your customer, then you’re going to lose that business, and you’ll just be churning,” he says.
