Aggregate Claim Audits

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.