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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 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 include:

  • Pre-binding audits
  • Due Diligence review for potential acquisitions
  • Third Party Administrator (TPA) audits to ensure compliance with Best Practices in the industry and/or to confirm claim handling is in compliance 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
  • Adjusting large catastrophic claims involving property loss, subrogation, business interruption and bodily injury

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 job sites 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.