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Third Party Administrator Audits

David Princeton

My passion for insurance has thrived for over 20 years. From humble beginnings as an auto-field adjuster to eventually serving as a Director of Corporate Risk for a private equity group. I’ve been involved in overseeing the challenges of insurance coverage across renewable energy, construction, aviation, information-technology, agriculture, beverage manufacturing, senior living, real estate, education,…

Michelle Villarreal

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…

Ralph Korn, CPCU

I have over fifty years’ experience in insurance and risk management.  I am a graduate of Loyola University, Chicago.  My corporate experience includes Director of Insurance for Duplan Corporation, Risk Manager for E. & J. Gallo Winery and Vice President of Insurance for Greyhound Corporation.  In addition, I have over thirty-five years’ experience as an…

Stephen Miller, CPCU, AIC

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…

J. Eric Peterson, Jr.

I have been in the insurance industry for over 30 years, working as a Licensed Property and Casualty Insurance Broker, Licensed Property and Casualty Insurance Adjuster and Litigation Manager for wholly owned, Captive Insurance companies.  I have also worked for the country’s top Third Party Administrative Companies. I currently hold Property and Casualty Insurance Broker…

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Chantal M. Roberts

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…

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.

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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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