Claim Audit & Training

CLAIM AUDIT

DMS’ Audit Team has performed claim management reviews for some of the largest and most recognizable insurers and reinsurers in the industry in the US and abroad. DMS’ audits range from comprehensive in scope to surgical. Areas of focus include:

  • Organization developmentOur claim auditing services are thorough and and accurate - we leave no box unchecked
  • Workloads
  • Workflow
  • Training
  • Skills and experience levels
  • Claim file documentation
  • Use of claim forms
  • Telephonic and written communication
  • Investigative tools
  • Deployment of specialized medical resources
  • Use of rehabilitation, return to work, and workplace accommodation
  • Financial offset management

DMS’ reviews typically include interviews with leadership personnel within a claim operation to provide an organizational overview, as well as an understanding of organizational objectives, challenges and practices.

DMS’ claim management reviews often result in the following outcomes for our clients:

  • Training needs identified
  • Process improvements feedback
  • Compliance with regulatory and client requirements
  • Enhanced decision making
  • Recommendations for further claim evaluation

In addition to its domestic operations, DMS is also experienced in supporting clients’ claim management needs internationally. Specifically, DMS serves as the third party administrator of individual Disability Income claims filed under policies issued in Canada and the administrator of long- term disability claims in Puerto Rico. Additionally, DMS administers short-term and long-term disability claims filed by U.S. ex-patriots living around the world. DMS has provided disability claims training and product and claim consulting for a Japanese insurer and claim audit, consulting and training for superannuation funds, insurers and reinsurers in Australia.