Claims and TPA services
We have expertise in the management of claims, across multiple classes of business on a global basis. This includes a specialism in private disability claims in Continental Europe and a large team of TPA specialists in the United States.
At Pro, our focus is your bottom line. We understand the issues that can affect the profitability of your business. Our approach is to handle your claims as if they were our own. Our blend of people, services and processes are dedicated to controlling costs and providing effective claims management.
- Claims management e.g. claims adjusting, strategic advice
- Negotiating with policyholders and cedants
- Independent expert advice during arbitration and litigation
- Reserve analysis and portfolio review: establishing ultimate liability on individual claims or entire portfolios using bespoke IT tools and enlisting our actuarial team where appropriate
- External and internal auditing e.g. data cleansing, static claims, peer reviews, process reviews, forensic reviews and inspection of records
- Claims administration to ensure efficient, cost-effective processing
- Technical claims support e.g. triage and indexation
- Evaluation, critiquing and negotiation of policy buy-backs and commutations
- Surge resource to cover peak periods of claims activity
US third party administrator (TPA) claims services
We have a full TPA operation and structure in place to receive, adjudicate, negotiate and report claims across multiple lines of commercial and personal insurance. Our multi-disciplined approach and worldwide team of experts allow us to support all aspects of the programme from underwriting and accounting controls to providing temporary resources to assist you during peaks in your business cycle.
Key elements of our client-led TPA Programme
To maximise your programme’s value, communication between all stakeholders is at the front and centre of our approach.
We do this by:
- Establishing clear and consistent loss reserving practices
- Proactive management of litigated claims
- Evaluating, expanding and contracting our nationwide panel of experts based on outcomes
- Recommending underwriting criteria enhancements
- Providing operational consulting and related services
- Seeking out new opportunities to create and develop new programmes.
Claim leakage service
The most common areas reviewed are:
- Workflow design
- Claims examiner and supervisor expertise
- Vendor rates and effectiveness
- Salvage and subrogation efforts
- Processing systems
- Extra-Contractual Obligations
- “Bad Faith” Exposures
Pro Claims Solutions GmbH, previously trading as Assekuranz, Service- und Sachverständigengesellschaft mbH, was founded over 20 years ago and is a leader for the provision of claims management services. Its specialisation lies in occupational disability insurance in the private insurance industry. Our clients include a number of high ranked insurance companies, which we support in individual cases as well as in entire claims audits. Our experienced and multidisciplined teams guarantee a competent provision of information to meet your needs and expectations.
- Occupational Disability / Invalidity Insurance
- Personal Accident / Life Insurance
- Sickness Daily Allowance Insurance
- Rehabilitation Aid and Assistance
- Training / Audits
Our track record
Some examples of the work we have done include:
- UK Company – undertake the administration elements of set-up, triage and message processing as well as adjusting claims up to an agreed authority limit
- Swiss reinsurer - support to reduce aged and large backlog of 7,436 claims. Triaged and adjusted claims in a timely and accurate fashion, resulting in improved practice and procedures and better service to cedants
- US insurer – strengthened company’s line of surplus through effective claims management. Reduced open claim volumes and reserves whilstcontrolling costs
We work closely with you to keep you fully informed through every stage in the development and execution of your claims strategy.
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