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Code of Practice - Auditing

PLS Claims developed a claims related audit program that will allow you to have your cover holders or TPA's, audited in an efficient and cost effective manner. We are positioned to help you with your audit and / or claims management requirements in any territory of the USA and on most classes of non marine business. We have an experienced team who can assist you in meeting your compliance objectives.

Some of the core areas reviewed are:

  • Timeliness of reporting, reserving, investigations and settlement of claims
  • Frequency of claim review
  • Selection, monitoring and management of third party experts
  • Coverage analysis
  • Bordereau Management
  • Accuracy of reserving
  • Pursuit of Recoveries where appropriate
  • Quality of customer (policyholder) service
  • Procedures for pro active claims management
  • Systems
  • Compliance
  • Breaches in terms of delegated contract
  • Open case loads by adjuster
  • Involvement of senior staff in claims process where appropriate
  • Access to and familiarity of agreements by staff

PLS Claims will initially have a meeting with you to get your specific instructions and report format requirements as we will provide the report to you in the format of your choice. Following the initial meeting we will send a detailed questionnaire to the Cover holder or TPA being audited to gather as much information as possible before the audit commences. This allows PLS Claims to review procedures and all the key areas of claims management before we arrive on site.

For further information or a meeting to discuss your requirements, please contact:

  Keith Webster
  kwebster@plsclaims.us
  Phone: 01206 266729 — Mobile: 07540049819