Group premium reconciliation, employee by employee — with only the real billing differences left for a person
Only the real billing differences left for a person to resolve.
See one case, screen by screen ↓It is matching each employer's premium payment to the carrier's list bill and to the enrollment the carrier holds, employee by employee and coverage by coverage, then explaining and fixing every difference. Group Premium Reconciliation does the matching with agents and leaves only the real billing differences for a billing analyst to resolve.
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Employers pay what they think they owe, not what the list bill says. The bill is built from enrollment as of the cutoff on the 10th; the employer pays from payroll; and the enrollment file keeps changing until the day the payment arrives. So every month the billing analyst exports the bill, pastes in the employer's self-bill spreadsheet, runs a VLOOKUP on employee ID and works every mismatch by hand — for one 645-employee account with four coverages each, about 2,500 premium lines.
What slips through is what costs money. A termination billed for months, then refunded past the contract's retro limit. A new hire covered but never billed. A salary increase never reflected in the life and disability amounts. Payroll moving an age-banded rate at the birthday when the contract moves it at the anniversary. Premium deducted for supplemental life still waiting on evidence of insurability, or for an election that was rejected — the error found at claim time. The small differences nobody can explain sit in suspense and get written off at quarter end.
Estimated split, in hours, for one employer's monthly reconciliation by hand and with the solution — from our persona time study.
Six agents match every employee across bill, enrollment and payment; the billing analyst resolves what differs and signs.
Corrigan Freight Lines was billed $44,244.06 for October coverage and paid $43,797.74 by ACH with its self-bill spreadsheet — $446.32 short. Here is what happens next, screen by screen, in the working solution.
The ACH lands with CFL Benefits Remittance Oct 2026.xlsx — 645 employee rows and 9 adjustments Corrigan wrote itself: terminations, late terminations, new hires and salary increases. The agents add six reading notes to the sheet, and find the line Corrigan did not itemise: “Other differences — not itemised”, $67.83.
“Corrigan did not itemise these. Found in the payroll detail: 2 age bands +$40.00 (payroll moved the rate before the 1 Jan anniversary), 2 evidence pending +$13.00, 1 election never enrolled +$19.20, 11 rounding −$4.37.”
The Enrollment history keeper rebuilds coverage from 6 enrollment files since the 10 Sep cutoff. The Bill matcher sets bill, enrollment and payment side by side for 645 employees across four coverages: 616 match to the cent, 11 within the $1.00 tolerance. The Variance explainer labels the 18 that differ — $1,198.57 gross — and the Retro credit calculator applies §7.3 of the policy.
List bill $44,244.06 − paid by Corrigan $43,797.74 = $446.32 short.
Payroll deducts $19.20 a month for Grace Holloway's $30,000 Voluntary Life, but her election was rejected on the 16 Sep file — date of birth missing — so she was never enrolled. Theo confirms the election with Joanne Ruiz at Corrigan and adds it from 1 Oct. Every enrollment change since the cutoff is on one screen: 14 changes in 6 files, none of them on the October bill.
“Had she died in October, the claim would have been denied.”
Nadia opens the bill with 17 of 18 differences open and $1,179.37 unresolved. Each row shows which of bill, enrollment and payment disagree, the three amounts, the cause and the proposed fix: credit $88.37 for Dale Pruitt's termination still billed, add $143.95 for Marco Tovar's October as a new hire not billed, refund $26.00 to Corrigan for Glen Ochoa because the age band moves on 1 Jan.
“I don't need help with the 627 lines that match. I need the 18 that don't, with the reason.”
Terminations still billed, new hires not billed, salary changes, age bands, evidence pending and the retro termination inside the limit are routine causes, so she accepts the 16 proposed fixes together. The variance bar falls from $1,179.37 to $560.00 — one employee left.
“16 fixes accepted · $560.00 left — Lucia Ferreira's retro termination.”
Lucia Ferreira, a salaried dispatcher in Columbus, was terminated on 30 June; Corrigan reported it on the 2 Oct enrollment file, 94 days later, and took back July, August and September on top of October. The timeline lays enrollment, billed, paid and the proposed fix side by side from June to November, with July marked past the limit and credit from 1 August. Creditable: August, September and October, $420.00. Past the limit and still due: July, $140.00.
Policy GP-51740 §7.3 — “Premium for a termination we are told of after its effective date will be credited for no more than two months before the first day of the month in which we receive notice. Premium for earlier months remains due.”
Before any credit, the calculator checks there is no life, STD or LTD claim since the termination date, and that the conversion and portability letter went out on 2 Oct — its 31-day window runs to 1 Nov because the termination came late. Crediting July as well would need an override, with a reason, sent to Martin Cole.
“An override needs Martin Cole's co-signature and a reason, and is recorded on the audit trail.”
Nadia applies the $420.00 credit and adds July to the employer notice. The last piece leaves the bar: all 18 differences explained, every dollar tied to an employee and a cause.
“Reconciled to $0.00 · every dollar tied to an employee and a cause.”
From the accepted differences the Notice drafter builds the walk from the bill to the balance: corrected October bill $43,889.11, July past the retro limit +$140.00, age-band refund −$40.00, $13.00 held in suspense for two evidence decisions, $4.37 of rounding written off. The letter to Joanne Ruiz quotes §7.3 and §4.2 and names employees by ID and initials only.
On the November bill: $100.00 due.
Nadia signs the corrected October bill — $43,889.11, with $100.00 carried to November and $13.00 in suspense — and sends the letter to Joanne Ruiz, copying Priya Venkat and the broker of record, Lakeridge Benefits Group. The agents drafted it; only she can send it.
The same October payment, seen by the four people who carry it — what their month looked like, and what it looks like now.
Six agents match every employee across bill, enrollment and payment; the billing analyst resolves what differs and signs.
Reads the employer's self-bill spreadsheet, PDF or 820 remittance and the ACH trace; extracts every employee line and every adjustment the employer wrote, and ties the summary to the cash received.
Builds every employee's coverage history from the enrollment files in date order: effective and termination dates, amounts, classes and rejected records, with changes after the bill cutoff flagged.
Sets bill, enrollment and payment side by side for every employee and coverage, and clears differences under the per-employee tolerance as rounding.
Labels each difference with its cause — termination or new hire after the cutoff, salary change, retro termination, age band, evidence pending, deduction without enrollment — and cites the enrollment record, the remittance line and the policy clause.
Applies each contract's retro limit to late-reported terminations and additions, lists months past the limit as due, and checks for claims since the termination and that the conversion and portability letter went out.
Writes the corrected bill and the employer notice from the accepted differences, quoting the clause for every amount the employer did not expect.
Accepts every fix · controller co-signs above limits. The agents propose; a named person decides.
Anyone on the billing team can ask in plain words — or tell it what to change. Every answer points to the file, the line or the clause.
Why is July not credited for Lucia Ferreira?
Her termination of 30 June reached us on the 2 October enrollment file. Policy GP-51740 §7.3 credits a late-reported termination for no more than two months before the month of notice — so back to 1 August. August, September and October are credited ($420.00); July's $140.00 stays due and goes on the employer notice.
What did Corrigan not mention in its remittance?
Corrigan itemised terminations, late terminations, new hires and salary changes. Five differences were in the payroll detail: 2 age bands moved early by payroll (+$40.00), 2 evidence-pending amounts deducted on the elected Voluntary Life (+$13.00) and Grace Holloway, deducted but never enrolled (+$19.20). Plus 11 rounding differences, −$4.37 in all.
Who is paying for coverage that is not in force?
Three employees on Corrigan's October payment. Tess Calloway and Owen Pierce pay on elected Voluntary Life above the $150,000 guaranteed issue while their evidence is pending — the $13.00 excess is held in suspense, not as premium. Grace Holloway paid $19.20 with no enrollment behind it; Theo Brandt confirmed her election this morning.
Draft the employer notice for Corrigan
Drafted from the accepted differences: corrected October bill $43,889.11, payment $43,797.74, and $100.00 due on the November bill — July for E-45262 under §7.3, less a $40.00 age-band refund. $13.00 stays in suspense. The letter quotes the clause and names employees by ID only. It can be signed when the match is at $0.
13 screens from the working solution, on its sample data. Pick one to see it large.
Tolerances, cutoffs, retro limits and approvals are settings — changed in place, versioned and on the audit trail.
| Setting | Default | Choose from |
|---|---|---|
| Rounding tolerance per employee | $1.00 | $0.00 to $5.00 |
| Match employees on | Employee ID and date of birth | Employee ID and date of birth · Employee ID and last four of SSN · Employee ID only |
| Bill cutoff | 10th of the month before | 5th · 10th · 15th of the month before |
| Grace period | 31 days | 31 · 45 · 60 days |
| Retro limit — contract default | 2 months before the month of notice | 2 months before the month of notice · 60 days before the notice · 3 months before the month of notice · 1 month before the month of notice |
| Groups with their own limit | Halden Precision Castings, Brightwater Dental Partners and Sable Creek Health Partners on 60 days · Pell Valley Schools on 3 months | Set per employer group |
| Check claims before a retro credit | On | On · Off |
| Controller co-signs | Martin Cole | Martin Cole · Martin Cole or Ana Lucero |
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
“demo” = seen in the working solution, on its sample book · “target” = the design goal, measured in the live solution · “estimated” = persona time study and our estimate · “typical” = published figures (NAIC Group Life Insurance Standard Provisions model — 31-day grace and conversion periods). ASC X12 834 and 820 are the industry's enrollment and remittance standards. People, employers, the carrier and every figure in the sample case are fictional — characters and sample data in the working solution.
It is matching each employer's premium payment to the carrier's list bill and to the enrollment the carrier holds, employee by employee and coverage by coverage, then explaining and fixing every difference. Group Premium Reconciliation does the matching with agents and leaves only the real billing differences for a billing analyst to resolve.
The Remittance reader reads the employer's self-bill spreadsheet, PDF or X12 820 remittance and the ACH trace in whatever layout the employer uses, extracts every employee line and every adjustment the employer wrote, and ties the summary to the cash received. The agents also flag the differences the employer did not itemise.
The Retro credit calculator finds the month of notice and the policy's retro limit, credits only the months inside it and lists the rest as due, citing the clause. In the sample case a 30 June termination reported on 2 October is credited for August to October, $420.00, and July's $140.00 stays due. It never credits past the limit; an override needs the controller and a reason.
Yes. Deductions for an election that was rejected, and premium paid on elected Voluntary Life above the guaranteed issue amount while evidence of insurability is pending, are labelled as their own causes. Premium for coverage not in force is held in suspense, never kept, and deducted-not-enrolled lines always go to a person.
Yes. Enrollment arrives as ASC X12 834 files or carrier layouts, and payments as ACH with an X12 820 or a self-bill spreadsheet. The Enrollment history keeper loads every file in date order and rebuilds each employee's coverage month by month.
Yes. Agents propose; the billing analyst accepts each fix and signs every notice. Write-offs above $25, credits above $2,500 per employer per month and any retro override need the finance controller's co-signature, and no agent posts cash, changes enrollment or sends to an employer.
Yes. The rounding tolerance, how employees are matched, the bill cutoff, the grace period, the default retro limit and per-group limits, the claim and conversion checks, which causes are accepted together and who co-signs are all settings, versioned and on the audit trail.
The Agentic Solution Engine builds and deploys it from your requirements and documents — your group policies, rate tables, list bills, enrollment files and a sample of employer remittances — and it goes live once every quality gate has passed. We will walk you through it on your own employer payments first.
Any census layout quote-ready the day the RFP arrives, every change on the record.
1-min demoEvidence of Insurability AutomationSimple EOI approvals stop waiting behind complex medical cases.
1-min demoDisability Claims AdjudicationExaminers decide on a full file, not a half-gathered one.
1-min demoWe’ll run Group Premium Reconciliation on a sample of your own employer payments, bills and enrollment files.