Healthcare Claim
Audit Services

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Providing peace of mind to our clients

Specialized expertise in health claim adjudication gives you peace of mind that the obligations of multiple parties are being honored and opportunities for cost management are occurring in your health plan. Our highly skilled and experienced staff take a consultative approach that recognizes the interests of all parties while delivering powerful results.

We regularly collaborate with self-funded employers, administrators, stop loss carriers, managing general underwriters, reinsurers, and insurance brokers to help settle health claim liabilities, supported by relevant facts and thorough review.

Our goal is to arrive at fair judgments based on a consultative approach that recognizes the interests of all parties while cumulatively saving millions of dollars. We are proud of the meaningful relationships we have built and the powerful results that deliver our clients peace of mind every day.

Our extensive range of healthcare claim auditing services includes:

Plan Sponsor Services

  • Targeted claim audits
  • Randomized claim audits
  • Operational reviews
  • Pharmacy Benefit audits

Stop-Loss Services

  • Specific Stop-Loss claims
  • Aggregate Stop-Loss claims
  • HMO Re claims
  • Provider Excess claims
  • Carrier claim audits
  • Reinsurer claim audits
  • Claim overflow management services
  • MGU audits
  • Administrator audits

Additional Consulting and Review Services

  • Plan Document review
  • Stop-Loss Policy review
  • General claim consulting
  • Complex claim reviews
  • Claim staff training

Solutions Expert

Kevin Egan
Managing Director,
Healthcare Claims Auditing

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