Audits of specific excess claims can either be accomplished on-site, at the TPA's
or carrier's facility, or sent to our offices to be reviewed by our Medical
Excess Facility claim staff.
We are capable of completing detailed line-item re-adjudications, if requested,
reconciling the adjudication made against the Plan Document, the excess policy,
or the reinsurance agreement. We make our recommendation to our client, who can
be the MGU, the carrier, the reinsurer, or the Lloyd's Syndicate, and often act
on their behalf in this capacity, being invisible to the TPA, if necessary.
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
This includes first dollar and self-funded programs as well as excess loss.