The proper handling of workers' compensation, general liability, and transportation claims can be an ongoing concern for organizations.
Our Claim Handling and Investigation Analysis Program is an independent review of the performance of your TPA. We will analyze if claims have been handled properly and if compensibility determination was properly investigated before making claim payments, if the payments made were accurate, and if the workers’ compensation injuries claimed were causally related to the work accident.
We provide a comprehensive review of:
Compliance with the carrier
Industry Best Practices
Special Handling Instructions
SLA Performance
Reserve Setting
TPA Performance
These areas are reviewed to analyze if the TPA has complied with their contractual obligations and if best practices are being followed in specific areas.
The findings of our review are documented in a detailed report consisting of our observations, recommendations and identify areas of improvement. The report also includes a data sheet reflecting areas of where potential savings and improved outcomes can be found which include:
Precise analytics
Reserves
Expenses - legal, medical, IA
Initial handling timeliness
Plan of action execution
Investigation quality check
Lag time
Subrogation opportunities
Upon completion of our detailed report, we submit a copy for your review and schedule a meeting to review the report in detail with the appropriate staff from your organization.
