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Claims Peer Review

Giving companies oversight to help reduce costs, identify trends and determine quality of their claims and complaints handling.

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Our Peer Review Services

Peer review involves a claim file review of claims and complaints handlers at the managing agent or insurer level. This can be on a delegated authority basis where TPA/DCAs refer into the team, or on an open market basis where claims are handled directly, or using Market systems such as ECF, CLASS, and IMR.

Our tailored peer reviews can focus on specific areas of concern, including but not limited to, leakage (hard and soft), subrogation, reserving and litigation management. These reviews ensure compliance with best practices or internal guidelines.

We can create a bespoke package that allows for trend analysis and provides recommendations tailored to your specific needs. This can be scheduled at intervals of your choosing and be as detailed as you require.

Otter Audit is an external, independent peer review partner.

We support a variety of clients and their peer review needs.

Otter Audit supports large international insurers and managing agents as well as national and niche insurance intermediaries, so that they can maintain high standards, improve efficiency and ensure that claims are processed fairly and accurately.

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Peer review has become an increasingly important step in maintaining a company's oversight of quality of handling, reducing costs, and identifying trends or training opportunities. Introducing an external, independent peer review partner can help to free up management's time to focus on other areas of the business.

In 2024 Otter Audit reviewed over 3000 files for 60+ clients

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Peer Review with Otter Audit

Our main peer review products are:

Claims Peer Review

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Claims peer review can be developed to establish a consistent and comparable view of the quality of claims handling by managing agents or insurer teams when measured against the requirements of internal guidelines or Lloyd’s Minimum Standards.

These requirements include but are not limited to:

Taking actions to resolve claims on their merits and in reasonable timeframes, considering circumstances of the claim.

Providing an appropriate level of service to policyholders and claimants based on the claim's circumstances.

Communicating actions and progress to policyholders and claimants where appropriate.

Taking appropriate steps in the appointment, management and oversight of third-party experts.

Identifying, monitoring and pursuing opportunities for subrogation and salvage where appropriate.

Ensuring that claims reserving is consistent, timely and accurate.

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Reserving Review

Reserving reviews include assessments of underlying claim details, a brief history, and key points of the claim throughout its lifespan. Specific comments are provided for any claims that are not reserved correctly or appropriately (including under and over reserving), which may breach the reinsurance program/layer or the SLAs contained within the claims handling authority.

We have expertise covering Insurance and Reinsurance programs specialising in most classes and territories.

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Complaints Review

Otter Audit has specialist auditors with expertise in conducting reviews of delegated authority complaints handling.

We understand the importance of the appropriate handling and monitoring of complaints, not just for regulatory compliance but also for a company's reputation and customer retention. Key areas considered in these reviews include:

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Effective recognition of complaints and escalations to the appropriate handlers.

Consistent, fair, and impartial handling of complaints.

Ensuring complaints are handled in line with local regulations and agreements in place.

Identifying gaps in complaint handling knowledge.

Reviewing the management information produced and the effectiveness of root cause analysis conducted.

Suitable oversight and consideration of complaints by senior management.

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Leakage Review

Hard leakage vs soft leakage. A review can be undertaken to ascertain if leakage is arising through the claims handling process.

Hard Leakage can potentially occur through erroneous or unnecessary payments, such as the unnecessary use of an expert or loss adjuster.

Alternatively soft leakage can occur through increased costs due to delayed claims handling, for example if a handler works on an hourly rate.

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Expertise in conducting reviews of delegated claims and complaints handling

Our Peer Review Team

Sam Ives, Audit Partner, leads the team and will be your initial point of contact. Sam has been in the insurance industry since 2005, starting as a claims handler and progressing to auditing delegated underwriting and claims.

Sam is supported by Business Operations and the Audit team.

Sam Ives

AUDIT partner

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What to expect with our Peer Review service

Our peer review process is flexible dependent on the services required.

Fact finding call

We’ll start with a fact finding meeting with our Audit Partner. From here we can understand the nature of your business and start to build a plan that works for you.

Meet your dedicated peer review specialist

We will introduce you to your peer review specialist, who will be your main contact throughout the project.

Develop your peer review plan

We will shape and develop the plan so that it enhances the oversight of the handling of your business. Allowing you to focus your time on other tasks and projects.

Regular meetings

We can include regular meetings with your peer review specialist to discuss trends and outcomes of the review.

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Got questions?

Who at Otter Audit will I talk to?

Initially, Sam Ives our Audit Partner, who will talk through how we might be able to support your business. Sam will allocate you the appropriate resource going forward.

What happens when my peer review specialist is away and I have a query?

Don’t worry! There will be cover in place to make sure you are able to get an answer as soon as possible.

Claims Peer Review

Our Peer Review Services

Peer Review with Otter Audit

Claims Peer Review

Reserving Review

Complaints Review

Leakage Review

Our Peer Review Team

Sam Ives

What to expect with our Peer Review service

Fact finding call

Meet your dedicated peer review specialist

Develop your peer review plan

Regular meetings

Got questions?

Who at Otter Audit will I talk to?

What happens when my peer review specialist is away and I have a query?

Otter Audit & Consultancy Services Ltd