Whether it's Adjudication, Administration, Audits or Process Reviews, we've got you covered.

We work with our clients to provide claims services that address the needs of their businesses. Whether you seek short or long-term support our services are designed with specific attention to data privacy and security.

We specialize in individual and group insurance claims for Life and Living Benefits solutions such as:

  • Accidental Death and Dismemberment
  • Critical Illness (including Return of Premium on Death)
  • Disability (including Residual Disability and Overhead Expenses)
  • Waiver of Premium
  • Long Term Care...

Our team of experts also specializes in complex contestable and foreign claims reviews.

Claims Adjudication

  • Reviewing claims documentation to ensure all necessary information is available
  • Providing written claims summary and recommendations
  • Managing communications with reinsurers (when applicable and as needed) while observing treaty agreements
  • Adhering to all established claims service standards and turnaround times

Claims Administration

Our team of claims analysts can provide administrative support for reinsured ordinary life and living benefits business.

We will work alongside you to develop and provide reinsurance claims administration services that fill your process gaps and resource needs, either on short- or long-term basis. We can provide support using your technology or work with you to have a customized solution within our environment. Our team is dedicated to meet your claims service level standards and turnaround times.

Ceded claims administration services

  • Unearned premium calculations
  • Reporting of claims to reinsurers
  • Managing claims reimbursements (receipt and application of cash and follow-ups)
  • Tracking and reporting of aging claims
  • Data analysis and trending
  • Process and controls documentation

Assumed claims administration services

  • Intake of claims (initial and final notices, validation of necessary requirements)
  • In-force cession and premium validation for reported claims
  • Processing of disbursements for death claims and living benefits, for individually settled, netted, or bulk claims
  • Data analysis and trending
  • Process and controls documentation

Retrocession claims administration services

  • Submitting payment requests and providing accompanying documentation
  • Managing follow-ups and tracking of retro claims recoverables
  • Allocating payments upon receipt

For all of the above, we also will provide data analysis, including trending, and process and controls documentation.

Claims Audits

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.

Our claims audit services include:

  • 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
  • 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

Claims Process Review

Our team of passionate claims experts will offer an independent claims process review, document findings, and recommend any changes to existing processes to consider for implementation. 

LOGiQ3's process reviews extend across all reinsurance functions in an organization and geographical regions. The objective of our claims process review is to help you understand your current processes, including any gaps that exist, and identify steps to make your process as efficient as possible, while ensuring your risk is understood and managed.

The scope of each process review may vary, depending on your business objectives and needs. Our process reviews include the following:

  • Gaining understanding of current processes, handoffs, and controls across the organization
  • Staff interviews to understand current challenges and desires for improvement
  • Identification of areas where there may be risk arising from or gaps in current processes
  • Recommendations for any changes to consider implementing in current processes

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