Pro.

Risk, audit and compliance

Claims peer reviews

Independent assurance

We evaluate and improve the effectiveness of adjusting, risk management, internal controls, and governance processes.

Independent reviews are critical to the ongoing upgrading of claims processes and they also contribute to maintaining and improving competitive advantages and corporate reputations.

Three key areas underpin independent audits:

  • Understanding, evaluation and improvement of claims management performance
  • Technical services - consistent adjusting across the team to ensure compliance with processes and industry best practices
  • Claims Management Information (MI) - reviewing management information so that data is suitable for internal and external management requirements

What we do

Pro's terms of reference for a typical claims review provide an overview of the claims control framework. We do that by providing feedback and/or independent opinion about the adequacy and effectiveness of the control environment within the claims division and the quality of the claims handling and reserving decisions.

As each project is unique, our standard terms of references are amended and agreed to at the start of every project so that we do exactly what you need us to do.

 

Typically, our claims review team will test and ensure:

  • That claims controls are working effectively and are fit for purpose;
  • Independent, timely and relevant assurance of the effectiveness of the claims controls to the Head of Claims and senior management;
  • Assurance that claims are being handled in accordance with any Claims Practice and Procedures document.
  • Any control or systematic failures are identified and actions relating to those variances are agreed to by the relevant people;
  • Follow-up on the status of recommendations and confirm that effective and timely remedial action has been taken.