Please tell us about yourself. We shall get in touch with you as soon as possible: Name: (required) Title: Organization: City, State: Interested in outsourcing our benefit administration functions in the following areas: CompuSys/Erisa specializes in group sizes of 500 to 25,000. Taft-Hartley Plan Administration 401(k)/457 Plans Administration and Employee Communication Medical/Dental Claims Administration Medical Case Management and Utilization Review COBRA Administration Flexible Spending Accounts Multi-Carrier, Multi-Line, Pre/Post Tax Payroll Deducted Voluntary Insurance Premium Administration Other Other: Employee population size: Contact via: (required) E-mail: Fax: Phone: Additional Comments:

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