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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:
  • 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 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


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 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 in it saving over $10 million.