Independent Claims Audit Services – Issues to Consider

claims audit

The management of an insurance agency can be a challenge. New business can be difficult (and expensive) to find and maintain. Customer retention may or may not depend on the price of insurance products themselves, but the service and knowledge of your agency provides. Most business owners consider insurance as a necessary evil, but most do not understand how it works, it is an intangible product. Unfortunately, the use of “product” only occurs after an accident, incident or disaster when the stress and tension are high.

One of the services it can offer its customers is continuing with the claims department for the state after the complaint was filed. Customers are not in the insurance business and the process can be confusing. However, no staff has the time and experience to get detailed updates of multiple claims handling multiple lines examiners coverage?

A periodic review or claims audit must consider whether your agency placed a large volume of business with an insurance company. If properly handled a complaint review may be an efficient, effective and proactive way to communicate with examiners insurance claim. Verification services to independent claim can provide beneficial review process facilitation statement that is not biased towards the insurance company or the customer by providing a neutral view of the facts and reserves.

Before hiring the services of a review of a complaint, there are some points to consider:

1) Does the claim has a background and made the service auditor an insurance company or self-insured? If the person elected to the audit claim does not have a fund, he or she will lose credibility with the staff insurance claim.

2) What business lines handled the auditor? If you intend to make a thorough review of the claim, including potential problems of coverage, then the person performing the audit should have background and familiarity with the coverage involved.

3) The auditor has experience doing a review of claims and / or experience of the agency?

4) Have you made audit objectives? Do you have a format established that would like to use? It is important to know what kind of information they are looking for before making the claim review. Areas to consider are the reserves, research practices, coverage issues and litigation management.

5) It is noted that the selection of files can be key to choose some files with high reserves, some with low stocks, some in the game, some not in the game, and so on. Choosing files with low body allows the tester to detect possible low booking trends within a claims department.

6) Be sure to give sufficient notice to the carrier. Giving the support of at least 30 days before a claim review will go a long way to build rapport between his agency and the insurance company. Adequate notice allows claims examiners and supervisory staff to review and prepare files for audit.

7) The opinion of being a “paper file” or an informal discussion conference call?

Review request should not be a witch hunt or gain an antagonistic attitude. When done properly, a lot of information can be exchanged between all parties in order to make the complaint process more peaceful for everyone involved. You may be able to provide information on behalf of his client that is useful for examining complaints and claims examiner may be able to provide valuable information about the status of the claim. Then you will be able to provide complete and comprehensive customer for updates. The provision of this service proactively adds value to your customers can be profitable to increase their rate of customer retention technique.

It claims that service providers be aware audit

Claims Audit services must be made on site to give auditors an opportunity to meet and interact with staff complaints and to make it easier to judge whether the skill level is adequate for the number and types of claims handled.

Nancy Germond has been providing insurance claims auditing, and professional legal copy writing services for years. Nancy is one of the most trusted and respected professionals within the insurance industry and she can help train your staff on how to perform better audits and write better advertising, legal docs, and much more