Using Claims Auditing Services To Monitor Self Insured Retentions (SIRs)

Reduce the cost of insurance for policyholders have access to SIRS. Some policyholder claims management departments to make internal claims, many TPAs ​​work for employment services. In either case, additional carrier to the policyholder's claim they have a more traditional "dollar" insurance program is being handled with little control over.

Than with more traditional programs with those involved in the processing of claims, there is a greater chance for error. TPA service providers and large claims by policyholders are protected from additional policy, but the additional carriers carry the burden if claims are being paid improperly can leave.

Preparing for Audit

Claims frequency and need for auditing services will depend on the situation. SIRS newly installed correctly to begin the process is sure to be audited more than once. The previous audits have revealed a large number of concerns, audit frequency should be increased. As the system becomes stable and reliable, audits can often be reduced. Many carriers use pre-binding audits - that is, send an auditing firm to audit the TPA service provider before they bind coverage, the coverage has been to find bad news, instead.

Auditors before the audit begins long to show up on the site. TPA services organization and policy to isolate and audit specific claims, and should be adapted to the specific needs of carriers. Auditor to gather information ahead of time Examples include (but are not limited) to claim counts as the pending claims and productivity levels, diary system, the most recent run of losses in the organizational chart, staff, starting levels of authority in the hands of staff reports and audit with the information as accurate and can be tailored to the needs of as wide.

Look for the claims audit service providers



Audit system in the early introduction of a claim, investigation, litigation management, processing, payment and recovery of claims, including all aspects of the deal should focus on speed and accuracy. Although many claims are routine, familiar and secondary insurance claims adjuster, third party liability and handle issues such as fraud in the daily workflow should be able to cope with these.



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