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Operational Audits

Claim Auditing

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.

Charles C Hewitt

Chuck Hewitt is a veteran insurance claims executive with 45+ years of multi-line claim department experience and leadership at national and regional carriers. Particular strengths in coverage analysis, creation, and teaching; bad faith defense; technical and management training; claims management; cyber liability; employment practices liability; litigation management; customer relations; reinsurance; and runoff operations. Multiple appearances…

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Craig Andrews

Craig Andrews is a Senior Consultant with Malecki Deimling Nielander & Associates, LLC.  Craig entered the property-casualty industry as a producer in an independent insurance agency in Defiance, Ohio in 1977.  A few months later, he established his own independent agency “from scratch”.  He operated the agency successfully until selling it in 1996 to join…

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James J Moore

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…

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Akos Swierkiewicz

Akos Swierkiewicz has over 47 years of experience in property and casualty insurance and reinsurance underwriting, management, company startup, marketing and product research and development. He founded IRCOS, LLC in 2000 to provide property and casualty insurance and reinsurance consulting and outsourcing services, including company startup and runoff, arbitration, mediation and expert witness services, feasibility…

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Britta M. Moss

Britta M. Moss, CPCU, SCLA, AIC-M is a Property & Casualty Claim Consultant and Expert Witness with nearly 25 years of experience in the insurance industry. She has been retained in both insurer defense and plaintiff cases in multiple states.  Her key strengths include claim handling best practices, industry standards and coverage analysis.  Britta brings a…

Dale Crawford

Dale is a 35+ year veteran of the insurance industry, from an underwriter trainee to president of an insurance company.  Along the way, he was also an officer at 2 reinsurance companies for 14 years.  The reinsurance experience provided an exceptionally broad view of the industry, dealing with numerous insurance company clients in standard lines,…

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