Workers’ Compensation Claim Audits & Management

Workers’ Compensation Claim Audits & Management

The most costly component of any self-insured Workers’ Compensation plan is the claims – those that are open, and those that have yet to occur.  The Third Party Administrator (TPA) is entrusted with processing claims, setting reserves, and managing claimants. KBM developed the Workers’ Compensation Claim Management Audit to verify the service provided by the TPA and to ensure they are performing their tasks in a compliant and cost effective manner.

KBM has audited the majority of regional and national TPAs; as a result of our broad client base we are familiar with the numerous software systems each organization employs and the limitations associated with them.  Our Audit Department is staffed by seasoned Workers’ Compensation claims professionals; many of whom have worked for the TPAs being audited.  KBM utilizes a detailed questionnaire, personnel interviews, system access, statistical analysis and claim management expertise to develop a report that details TPA processes, reserving practices and vendor management.

The audit is designed to provide our clients an assurance that their benefit administrator is performing at the level committed to in the contractual agreement.  If claim administration falls below industry standards, recommendations are made to improve performance or seek alternative TPA’s.   The KBM Audit Department is staffed by those previously employed in the TPA industry; their “inside” knowledge, in conjunction with on-going training, makes this service a formidable tool in the management of a benefit plan.

We offer our Auditing services to our existing clients as well as a stand-alone service to other self-insured entities.

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