At Salt, we perform audits/reviews on any claim that involves a disability determination, including Short Term Disability, Long Term Disability and Life Waiver of Premium claims. We have designed a methodology, assembled an expert staff, and built technology around an audit process that provides consistent results. We are empathetic in our approach. Having worked for and managed claim organizations, we understand what it’s like to have outsiders on the floor. We realize that we are your guests and and we work hard not to disrupt your day.
We’re often engaged by:
- Carriers who need assessment of their claim practices and risks
- Reinsurance Companies who involve us in working with their customers
- Employers interested in the performance of their claim administrators
- Brokers and consultants wanting independent expertise for their customers
- Third party administrators who may want an assessment of a new block of takeover claims
Our experience in this practice is deep, as each of our Claim Analysts has over 5 years minimum claim administration experience with carriers and/or TPAs. We’ve performed over 100 audits and operation reviews in the last 12 years in 33 different claim operations, translating into data analysis and review of over 131,000 claims representing billions in reserves for LTD and LWOP.
Our proven methodology is highlighted by use of claim data, our proprietary audit tool (SaltGear), and claim selection process. Collection and assessment of claim data is integral to performing a successful audit. The data analysis includes an integrity check (scrubbing), segmentation, prioritization, and a recommended set of criteria from which to select claims for the audit. The claim selection criteria expose themselves after careful review of red flags and trends discovered during this analysis.
Claim audits vary by project, however, typical examples of the discovery process include:
- Finding consistency in following the prescribed workflow
- Evaluation of staffing, case loads, and case load characteristics
- Calculating timeliness of actions
- Looking for appropriate claim file documentation
- Using risk management tools and techniques
- Examination of STD to LTD transition
- Analysis of communications
- Assessment of telephone use
- Change in definition
We’re able to uncover opportunities for improvement, as well as validate an organization’s assumptions. Our clients receive a data analysis report,recommendations and possible claim strategies, a report package from SaltGear, and copies of claim file plans for each claim reviewed. Through the claim data analysis alone, we typically uncover savings that more than pay for our engagement.