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Operational Audits
Michelle Villarreal began her claims career over 30 years ago, with Cigna Companies while attending St. Mary’s University in San Antonio. She is the President and CEO of Occupational Accident Risk, Inc, a Third Party Administrator specializing in Texas work injury programs. They have been in the Third Party Administration industry since 2006, offering services…
Richard Faber is a highly experienced insurance professional who possesses a wide array of skills and a distinctive combination of experience, ranging from marketing, and consulting to managing/underwriting a staggering array of risks. His background and extensive experience work together to make Richard a much sought after authority in his field. Richard began his career…
Frederick J. Fisher, J.D., CCP, is the President of Fisher Consulting Group, Inc., and was the Founder of E.L.M. Insurance Brokers, a Wholesale & MGA facility specializing in Professional Liability and Specialty Line risks. He is a Member of the Editorial Board for Agents of America; a Faculty Member of the Claims College, and Member…
David Stegall is the Principal Consultant and Founder of Risk Consulting & Expert Services (RCES) since January 1, 2007 with over 45 years of insurance, reinsurance, bond and risk management industry experience. He is a Chartered Property & Casualty Underwriter, an Associate in Risk Management, an Associate in Reinsurance and a Registered Professional Adjuster. He…
The claims audit is the anathema of day-to-day claim operations. Nothing is more disruptive. Yet, if properly defined, nothing is more informative and helpful in improving a claim management program. This article will examine the need for a regular auditing program and provide a recipe for a three-dimensional approach to the process in order to maximize the accuracy of the audit results.
The need to conduct regular claims audits has already been widely discussed. With the magnitude of self-insured claims programs (including self-funded programs) and the millions of dollars spent on claim administration fees, what better way to verify whether the money spent has been justified or wasted? In essence, an audit of closed and open claims should accomplish several things.
James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies…
An interpreter of “insurance-ese” assisting others in understanding insurance policies, procedures, and practices of the industry. Expert Witness/Litigation Consultant in P&C coverages and Agent/Broker “Best Practices”. Four decades of insurance program development in the specialty P&C insurance space. Skilled in the identification, analysis, evaluation, and treatment of complex risk and loss exposures. Insurance Educator for…
Dave has been retained in over 150 cases as a consulting or testifying expert on insurance claim handling standards and practices in both state and federal courts in a variety of jurisdictions, both at deposition and trial. He has been qualified to testify in Washington and Oregon state courts and the United States District Courts…
