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Claims Auditing

Enlist an expert eye. Ensure flawless claim filings.

Don’t miss a thing. AMS claims audits are performed by experienced professionals that ensure the completeness and accuracy of every claim before adjudication.

Aggregate Claim Reviews

We guarantee expert reviews that assess the accuracy and compliance of aggregate excess claims filed by TPAs or ASO carriers. Through careful analysis of the Plan Document and stop loss contract, we perform checks that catch any errors in payments, verify transaction amounts, and identify excluded claims. An AMS Aggregate Claims Review is a means to adjudicate with confidence.

MGU Claim Reviews

AMS provides MGU claim reviews to assess all policies, procedures and protocols employed by the MGU in the identification, adjudication, and reimbursement of specific and aggregate excess claims. Audits also have optional components, such as audits of premium administration or audits of TPA oversight, for those looking for a deeper analysis of their operations and procedures.

Other Audit Services

AMS can assist with complicated specific excess claims, analyze reinsurance and excess contracts and claims, perform due-diligence audits of TPAs for employers, carriers and reinsurers, and other audit services as requested and required by clients.  The Scope of Audit will be personalized to the individual client’s concerns and desired outcomes.