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Claims Auditing

Claims Auditing
Investing in claim auditing services is a proactive and cost effective way to impact a carrier’s bottom line. Providing services on an international level, the Claims Auditing practice covers virtually all lines of insurance claims, including environmental, mass tort, products liability, auto, construction defect, workers’ compensation, health care, professional liability, and commercial property. Our auditors average over twenty-five years of experience, and many have held senior management positions at major Property & Casualty carriers. This experience gives us a complete understanding of the issues and problems that our clients are faced with.

 

Services include:
  • Pre-underwriting audits to verify loss histories reported from prior carrier(s)
  • Pre-settlement audits to validate claims history being reported prior to settlement discussions
  • Post settlement audits to verify that terms and conditions of settlements are being adhered to
  • Third Party Administrator (TPA) audits to confirm the level of service provided meets industry standards and/or service agreements entered into by parties
  • Review of Self Insured Retentions (SIRs) to confirm proper exhaustion
  • Operational reviews of entire claim departments
  • Arbitration and litigation support including expert witness testimony

SAMPLE ENGAGEMENTS:

Global Client Operational Audit
An operational audit of an international client’s claims department resulted in complete reorganization of staffing levels and procedures. Reserve reductions totaling over $25,000,000 were realized based on Alan Gray LLC’s file audit and the open file inventory was reduced by 35%.

Complex Reinsurance Contract (Healthcare)
A client requested an audit of claims under a complex reinsurance contract involving a large hospital group and multiple years of medical malpractice coverage. The audit identified a significant claim with serious coverage issues under the client’s contract resulting in savings of $1,000,000 for the client.

Audit Identifies Significant Percentage of Claims as Non-Products
A global insurer requested a comprehensive audit and analysis of claim files and related jobsites to develop a model for non-product allegations. The insured was a distributor/contractor but was billing all losses as products. The audit identified a significant percentage of claims as non-products. The client was able to utilize this information to negotiate a settlement that resulted in savings of over $10,000,000.