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Third Party Administrator 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…
Steve is a 30+ year veteran of property and casualty insurance claims. He holds the CPCU and AIC designations and is Past President (2006) of the National Society of Professional Insurance Investigators (NSPII). Over the course of his carrier career, Steve worked as a direct claim handler, manager, litigation examiner, senior claim specialist and director…
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…
I am dedicated to providing trustworthy, valuable assistance in order to give my clients a clear understanding of claims standards and practices. As an expert witness, I strive to turn this complex topic into an easy to understand concept. Known for my honest and direct approach, I work hard to meet each of your individual…
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…
Jim Greer’s experience spans thirty-eight years in the insurance adjusting and claims administration industry, beginning with a variety of field and home office assignments with Aetna Life and Casualty’s P&C Claim division. After excelling as a claims professional in various field and home office management positions, he became a key participant in several business and…
