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.