Healthcare Claim
Audit Services

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

Stuart Piltch

President - Risk Strategies Consulting

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