Auditing
TPA Auditing Program
A famous American once said, "trust but verify." It is important that carriers be able to trust their TPA handling their claims. However, it is also the same carriers responsibility to ensure that the TPA is fulfilling compliance with agreed service standards. We can help you with this.
In today's claim environment, TPA resources are strained. Competitive pricing structures in which TPAs operate force them into a business model that pits profitable for them against and effectiveness in handling your claims.
In the current market, seasoned adjusters leave and are replaced by less experienced, lower salaried adjusters. The remaining adjusters are strained and they end up working excessive caseloads. You foot the bill for the final cost of claims.
We have an effective claim solution. Our TPA Audit Program adds the layer of oversight that is missing from the success equation. Our program ensures the success of your claim program by providing an all-inclusive approach to case and TPA management. We will be available for meetings to discuss our findings.
For a fraction of the cost you would incur for a staff auditor, we can:
- Conduct operational audits to ensure compliance to agreed standards
- Conduct regulatory agency audits to ensure compliance with the law
- Direct the activity of the adjusters in very specific ways on select individual cases
- Work with TPA management to develop action plans to reach the most effective case closure or containment