ClaimSecure

What ClaimSecure does

ClaimSecure is a Canadian Administrative Services Only (ASO) provider that administers drug, health, dental, and healthcare spending account benefit plans on behalf of plan sponsors — primarily employers and unions — across Canada. Founded in 1983 and headquartered in Sudbury, Ontario, the company operates a platform built around its proprietary Falcon claims adjudication system, which processes drug, health, and dental claims with routing and validation logic, and is complemented by a three-portal eProfile ecosystem (Member, Provider, and Plan Administrator) delivered via web and mobile (iOS/Android) channels. Layered on top of the core platform are cost-containment modules including Formulary Protect (specialty drug management), a Preferred Provider Network (ValueHealth and Postscripts), a Fraud, Waste and Abuse program with a dedicated Special Investigations Unit, Special Authorization clinical review, and Specialty Drug Program risk management. Pharma partner offerings — card solutions and lifecycle analytics — extend the platform into market-access services for pharmaceutical manufacturers.

Since its 2021 acquisition by Canada Life (La Compagnie d'Assurance du Canada sur la Vie), ClaimSecure has operated as a wholly-owned operating subsidiary while retaining its independent brand. The go-to-market is sales-led with account executive coverage of plan sponsors, supplemented by an insurance advisor/broker referral channel and direct digital self-service through the eProfile mobile and web apps. Revenue is generated via negotiated ASO administrative fees paid by plan sponsors for claims processing, plan management, clinical programs, and technology services — pricing is not publicly disclosed and varies by plan design, employee count, and service scope. SecurePak (launched April 2022) bundles ClaimSecure ASO with Canada Life pooled insurance products, and Freedom to Choice directs departing members to an individual Canada Life health and dental product. The company serves 101–250 employees and operates a Canada-wide Customer Response Centre with the longest operating hours in the industry (8am–9pm EST Mon–Fri, Sat 11am–4pm for providers), with bilingual English/French support.

Name

ClaimSecure

Legal name

ClaimSecure Inc.

Website

https://claimsecure.com

Company type

Private

Founded year

1983

Operating status

Operating

Headcount range

101–250 employees

Short description

ClaimSecure is a Canadian ASO provider that administers drug, health, and dental benefit plans for employers and unions via its Falcon adjudication engine and eProfile member, provider, and plan-administrator portals; the company is a wholly-owned subsidiary of Canada Life since 2021.

Ownership category

akta.pro rank

Product category

Health Benefits Administration

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Claims Adjusting (524291)

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)

akta.pro primary industry

Claims Administration & Payment Integrity (Medical/Dental/Vision) (HLAEALAD)

akta.pro secondary industries

Trust, Safety & Risk Support (Fraud, Abuse, Policy Enforcement) (BPAAABAI), Claims Adjudication & Rules/Edits Configuration Support (BPAAAFAE)

Keywords

• Benefits administration
• Claims adjudication
• Health insurance
• Pharmacy benefits management
• Specialty drug management

Headquarters

HQ city

Mississauga

HQ country

Canada

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Technology or R&D, Operations, Infrastructure, Marketing or Sales, Supply Chain, Others

Revenue model

1. Administrative Services Only (ASO): ClaimSecure provides ASO services where they administer drug, health, and dental benefit plans on behalf of plan sponsors (employers, unions) without bearing insurance risk. Plan sponsors pay administrative fees for claims processing, plan management, and technology services.

Go-to-market motion2 records

Distribution channels5 records

Marketing channels5 records

Core offering

ClaimSecure is an Administrative Services Only (ASO) provider that administers drug, health, and dental benefit plans on behalf of Canadian employers and unions via its proprietary Falcon claims adjudication engine and the eProfile member/provider/plan-administrator platform. Members submit claims and manage coverage through the eProfile mobile app and web portal, while plan administrators access online enrollment, eligibility, reporting, and analytics dashboards. Complementary modules cover specialty drug cost containment (Formulary Protect), preferred pharmacy pricing, fraud/waste/abuse prevention, healthcare spending accounts, and bundled offerings with parent Canada Life.

Product overview

ClaimSecure is a Canada-wide drug, health, and dental benefit plan administrator with over 40 years of experience. The company offers a platform-based architecture centered on the Falcon claims adjudication system, complemented by multiple eProfile portals (member, provider, and plan administrator) delivered via web and mobile applications. Add-on modules include Formulary Protect for specialty drug management, a Preferred Provider Network, Fraud/Waste/Abuse program, SecurePak (Canada Life pooled products), and white-label branding options. The eProfile Mobile App serves as the primary interface for members to submit claims, view coverage, and manage benefits, while the Provider Portal enables healthcare providers to access explanation of benefits and verify coverage. Plan Administrator tools provide online enrollment, eligibility management, and reporting capabilities. Pharma partner solutions include card programs and analytics services.

Differentiator

Problem solved

Functional benefit

Brands

• eProfile™: Mobile app and online platform for members to manage their health benefits, submit claims, view coverage, and access direct deposit.
• Falcon
• SecurePak™
• Formulary Protect
• Freedom to Choose™

Products and services

• Health & Dental Administrative Services Only (ASO) Core ASO offering for Canadian employers and unions combining centralized billing and administration of drug, health, and dental benefit plans with fully insured solutions.
• eProfile Mobile App Mobile application (iOS and Android) for plan members to submit eClaims and PhotoClaims, view coverage and balances, enroll in direct deposit, find providers, and access an electronic benefits card; enhanced with new in-app registration and features in 2023.
• Member eProfile Portal Web portal for plan members to submit claims, view coverage and balances, manage direct deposit, and access personalized health information administered by ClaimSecure.
• Provider eProfile Portal Online portal for healthcare providers to access electronic explanation of benefits, enroll in direct deposit, verify member coverage, and receive eBulletins from ClaimSecure.
• Plan Administrator eProfile Portal Online tools for plan administrators to manage day-to-day account administration, flexible plan designs, online enrollment and eligibility, reporting dashboards, and invoicing for ClaimSecure-administered plans.
• Falcon Claims Adjudication System Comprehensive claims adjudication system that processes drug, health, dental, and healthcare spending account claims with advanced routing and validation for eligible benefits.
• Formulary Protect Specialty drug cost-management solution that protects benefit plans from the financial impact of high-cost specialty drugs, including coverage navigation services to help find alternative funding.
• Specialty Drug Program Risk management program that optimizes the use of benefit dollars for specialty drugs across the formulary.
• Preferred Provider Network National prescription drug savings program through exclusive retail and online pharmacy partnerships with ValueHealth and Postscripts.
• Fraud, Waste and Abuse (FWA) Program Industry-recognized program, staffed by a dedicated Special Investigations Unit, to prevent and detect fraud, waste, and abuse in healthcare claims.
• SecurePak Bundled offering combining ClaimSecure's Administrative Services Only (ASO) services with Canada Life's pooled insurance products.
• Special Authorization Clinical review process for high-cost or potentially inappropriate drugs where members must meet pre-established clinical criteria for coverage.
• Healthcare Spending Accounts Flexible spending account solutions that allow plan members to manage healthcare and wellness expenses through their employer-sponsored plan.
• White Label Custom Branding Custom white-label branding of ClaimSecure's administrative services offered to clients under their own brand.
• Pharma Partner Card Solutions Patient access card solutions for pharmaceutical manufacturers including bridge-to-reimbursement cards, financial assistance programs, and loss-of-exclusivity card solutions to support patients across the product lifecycle.
• Pharma Partner Analytics Analytics capabilities using private insurer data to support pharmaceutical partners across the product lifecycle, from pre-launch market understanding to post-launch progress tracking.

Segments4 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration4 records

AI capability3 records

Feature6 records

Partnerships

Three partnerships are on record, tiered flagship and core.

• Canada LifeflagshipStrategic or Co-development Partner · 1 January 2021In 2021, ClaimSecure was acquired by Canada Life. This provides ClaimSecure with the backing of one of Canada's largest insurance companies while maintaining its brand identity. Products like SecurePak combine ClaimSecure's ASO services with Canada Life's fully insured products. Canada Life also offers 'Freedom to Choose' individual health and dental insurance which ClaimSecure directs retiring/members to.
• ValueHealthcoreStrategic or Co-development PartnerExclusive national prescription drug savings program through ValueHealth's retail and online pharmacy network. Provides ClaimSecure plan members with unmatched savings and convenience on prescription medications through participating pharmacies.
• PostscriptscoreStrategic or Co-development PartnerExclusive online pharmacy partner network offering drug savings programs for maintenance medications. Part of ClaimSecure's preferred provider network strategy for cost containment.

Scale indicators2 records

Recent moves6 records

Expansion highlights6 records

Regional players

• Pacific Blue Cross: British Columbia-based benefits administrator providing group health, dental, and drug plan administration; regional peer with comparable ASO and adjudication capabilities.
• Medavie Blue Cross: Atlantic Canada-based not-for-profit benefits administrator offering group drug, health, dental, and travel coverage with administrative services for employer and government plans; regional peer with similar TPA model.
• Saskatchewan Blue Cross: Saskatchewan-based benefits administrator providing group health, dental, and drug plan administration with member-facing digital tools; smaller regional peer with comparable service model.
• Alberta Blue Cross: Alberta-based benefits provider administering group health, dental, and drug plans with proprietary PBM and provider networks; comparable in scope and model to ClaimSecure within its province.

Broad incumbents

• Manulife Group Benefits: Major Canadian insurer offering fully insured and ASO group benefits plans with administrative services bundled to underwriting; a broad incumbent that competes with ClaimSecure on large employer accounts.
• Sun Life Group Benefits: One of Canada's largest group benefits carriers offering health, dental, and drug coverage with in-house administration; competes head-to-head with ClaimSecure for employer and union plan sponsors.
• Industrial Alliance (iA) Group Benefits: Canadian insurer offering group benefits plans with drug, health, and dental coverage including ASO arrangements; competes with ClaimSecure especially in Québec and Ontario employer segments.
• Desjardins Insurance: Québec-headquartered cooperative insurer offering group benefits including health and dental coverage with admin services; broad incumbent competitor in the Canadian group benefits market.

Direct peers

• Green Shield Canada: Canadian not-for-profit health and dental benefits administrator offering drug, health, dental, and vision plan administration with its own PBM and provider network; the closest direct peer to ClaimSecure in Canadian group benefits TPA.

Emerging players

• Equitable Life of Canada: Canadian mutual insurer offering group benefits including health and dental coverage with flexible plan designs; smaller-scale peer competing for mid-market employer group benefits accounts.

Market position

Strengths4 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• YouTubeyoutube.com/channel/UCwql_dTsojTOrQtd7x3E4WQ
• LinkedInlinkedin.com/company/683582
• Xx.com/claimsecure

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about ClaimSecure