Complementing an Actuarial Review with a Claims Review

Despite the fact that a claims review can greatly benefit both a company's profitability as well as an actuary's reserving analysis, they are often overlooked as a tool. Our presentation will include triggers that actuaries should look for to suggest claims reviews, details of what a claims review should include, as well as how both the company and the actuary can benefit from the results of the claim review. Examples from actual experience will be provided.

Specifically, we will discuss the development of a claim self assessment questionnaire that will calibrate claim professional adjudication practices to meet or exceed leading practices. Panelists will then discuss the development and utilization of key performance indicators to monitor claim activity which impacts the overall loss ratio improving the profitability of the portfolio.