Audit Services
Every review is tailored to meet a client’s specific requirements. However, if we notice something ‘outside core requirements’ we do flag this.
Data can be crucial when deciding on review areas to focus on, and we have the claims / actuarial knowledge, expertise and systems to help with this.
We have also developed unique systems to help with random selection of claims (RCS©) and the audit process / analysis and reporting (eClams©).
Below are the 3 key business areas we focus on for audit services. We can review all aspects of a claim or individual areas only as required.
Key Business Areas Covered
Our auditors understand the operational and technical complexities of vehicle damage, personal injury, liability decisions and indemnity spend, helping insurers improve accuracy, efficiency and cost control.
Specialist review areas include:
FNOL and data capture
Policy cover
Liability
Reserving / Financials
Insured and third party claim costs
Credit hire
Fraud
Suppliers
Consumer duty / compliance
Best practice
Our auditors bring extensive experience in accident and health claims, within the domestic PMI, iPMI, Travel medical and Assistance Medical sector, with a strong understanding of medical evidence assessment, benefit validation and fair customer outcomes.
Specialist review areas include:
Medical evidence and clinical validation
Reserves / Financials
Billing accuracy
Claims duration and ongoing eligibility
Policy benefit and exclusion application
Fraud
Suppliers
Consumer duty / compliance
Best practice
Provided by our highly experienced claims auditors who are also pet owners, allowing us to bring added technical insights and experience of navigating veterinary services and claim submissions.
Specialist review areas include:
Pre-existing conditions
Clinical validation
Reserves / Financials
Billing accuracy
Ongoing eligibility
Fraud
Suppliers
Consumer duty / compliance
Best practice