Home     Services     Profile     Contact     Affiliates

Aggregate Claim Audits can be conducted for stop loss carriers, managing general underwriters and reinsurance carriers. These audits are conducted either on-site or in our office. Before an on-site audit occurs, members of our staff coordinate a meeting time with the claim payor and review all essential information relating to the process of claim adjudication.

The Aggregate Audit consists of:

• Verification that proper claims and reporting controls exist.
• Verification of funding in relation to the provisions of the excess loss policy.
• Attachment Point verification.
• Eligibility review and excess loss premium remittance.
• Underwriting review.
• Identification of extra-contractual payments.
• Review of adjustments and returned checks during and after the policy period.
• Claim audit.
• Review of Plan Document.
• Aggregate Policy review.
• Confirmation of reported claim totals.

top