Similar to our administrative audit services, LOGiQ3 has a well-defined claims audit program.
Our program is designed to include a process review of the overall claims function from the reporting of claims, claims adjudication, verification of amounts ceded and deducted, calculation of applicable interest and/or other amounts such as expenses and adjustments, to regulatory compliance. Upon completion of the claims audit, we will provide all onsite notes, documents, and an audit report suitable to share with interested parties.
Is this Solution Right For You?
Not sure if you need help with your claims audits? We can help you solve these problems:
- You have your own audit program but don't have a dedicated team of auditors to complete planned claims audits
- You do not have a formal audit program nor an audit team to perform claims audits
- Your staff is very inexperienced in conducting claims audits and require training in order to perform audits going forward
- During peak times, you do not have access to your in-house audit expert to manage scheduled audits and coordinate with clients on audit efforts
Read our real life client engagements below to illustrate the types of problems we have solved:
Problem: A US reinsurer, committed to complete an on-site claims audit but did not have sufficient resources or experience to staff from within.
Solution: LOGiQ3 provided a team of claims experts and auditors to complete their onsite claims audits to include - review of claims processes, treaty compliance, regulatory guidelines, claims payment and billing process.
Results: The client was able to complete claims audits scheduled on the calendar and received claims report of findings.
In addition to claims audits, we also provide other claims services such as claims administration, claims adjudication, and claims process reviews.
The following are features to our claims audits:
- Claims case sample selection from a specific time period
- Claims currently in litigation as a part of claims case sample
- Claims process and controls including quality assurance and escheated claims
- Treaty compliance
- Adherence to claims regulatory requirements including unclaimed property
- Adjudication management process
- Accuracy of claims disbursement, payment, and billing process
- Review of claims interest calculation
Additional services include:
- Claims Audit Training and Mentoring
- Claims Audit Program Design
By allowing LOGiQ3 to assist with your administrative audit needs, you will gain the following benefits:
- Access to Dedicated Claims Experts - Our team consist of auditors that have in-depth claims knowledge. We know the right questions to ask and understand the downstream impact of various functions as it relates to your reinsurance business.
- Reduction in Time - Our average delivery time for a complete audit report is three weeks from the time of the onsite audit.
- Reduce Disruption of Day to Day Operations - Engaging us to help with your claims audits results in less disruption of your day to day operations as your staff need not be away from your office.
- Commitment to Meet Audit Timelines - we work towards timelines from a customized statement of work to ensure you meet your audit schedule.