Audit, Accounting, and Risk Management

Claims Auditing

Service Overview

Investing in claim auditing services is a proactive and cost-effective way for a carrier to positively impact its bottom line. Providing services on an international level, the Claims Auditing practice covers virtually all lines of Property & Casualty Insurance, 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 Performed

  • Claims Handling Best Practices
  • Due Diligence review for potential acquisitions
  • Third Party Administrator (TPA) audits to ensure compliance with Best Practices in the industry and/or  with specific service agreements
  • Review of underlying coverage or Self Insured Retention (SIR) to confirm proper exhaustion
  • Claim operation reviews to increase productivity
  • Arbitration and litigation support, including expert witness testimony
  • Property claims, subrogation, and business interruption

Additional materials

Learn more about our services and how they can help your business.

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Sample Engagements

Global Client Operational Audit

An operational audit of an international client’s claim department resulted in a 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 an insured’s claim files and related jobsites to develop a model for non-product asbestos allegations. The insured was a distributor/contractor but was billing all losses as asbestos products losses. The audit identified a significant percentage of the audited claims as non-products asbestos claims. The client was able to utilize this information to negotiate a favorable settlement with the insured that resulted savings of over $10 million.

Claims Auditing

 Professionals

Meet the team.

Normand Vermette

Managing Director

Normand Vermette

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Paul M. Roach

President

Paul M. Roach

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Katherine A. Hawke

Managing Director

Katherine A. Hawke

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Alan H. Gray

Founder & Executive Vice President

Alan H. Gray

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John Goldwater

Managing Director

John Goldwater

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Jeff Genereux

Senior Consultant

Jeff Genereux

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James B. Flaherty

Director

James B. Flaherty

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Steve Ceppi

Senior Investigator

Steve Ceppi

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Kevin F. Barber

Senior Auditor

Kevin F. Barber

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Richard G. Grant

Director

Richard G. Grant

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