We verify how the MGU/MGA,
coverholder, or excess carrier receives, manages and, ultimately, reports medical excess claims up the market chain.
An on-site audit
of the subject is the most effective method of gathering and reviewing the necessary information. These audits typically include meetings with key management and claims staff, to determine who is involved with the business under review and their overall and actual experience level. We hold a technical discussion with the senior claims staff on the claims handling systems and procedures (from receipt of a potential excess claim through the eligibility confirmation process and actual claim payment) to ensure that the processes employed conform with those intended and to accepted industry standards.
If the audit subject utilizes the services of outside firms to assist them in their findings, we will review an adequate amount of documentation to confirm that the outside firms employed are acting appropriately and in accordance with industry expectations.
Our staff of claims professionals, based on many years of industry experience and using our sophisticated claim sampling technique, help clients assess the accuracy, efficiency, and timeliness of the work performed by claim paying entities.
This includes first dollar and self-funded programs as well as excess loss.