Essential Services & Programs (ES&P) is a third-party administrator that provides Claims Auditing & Consulting Services to our clients. Whether worker’s compensation; general liability or automobile claims management we can assist you by conducting an independent claims audit of your program(s). We provide these services to employers, insurance companies, reinsurance companies and regulators.

Our goal is to help each client find a way to maximize their claims management and administration while mitigating their costs for each claim by utilizing a totally independent audit without conflicting interests.

Whether claims are administered by an insurance company or by a third party administrator (TPA), their services are critical in maximizing the value of a program(s). Errors made in claim handling and reserving will result in excessive costs to clients. Reserving must be accurate and claims must continually move toward closure.

Our process includes:

Ensuring Best Practices are being handled in all areas of claims processing. We are 100% focused on facilitating claims management improvement. Specifically, our audit involves:

• Review of internal policies and procedures

• Thorough audit of claim files to include

  • Claim management

  • Litigation management

  • Reserve adequacy

  • Expense control

  • Subrogation and Second Injury Fund recovery (W/C)

  • Statutory, Contractual & Excess reporting compliance

  • Development of a plan of action to expedite resolution of claims

• Risk Management Alerts & Pre-Accident Loss Prevention Analysis

• Claims monitoring and follow up with internal audit recommendations

• Identify areas of training beneficial to your program(s)

• Acquisition evaluation audits

• Second opinion on large, litigated or settlement claims

• Return to work programs (W/C)

• Detailed report analyzing both valid and opportunities within the program(s)

The competitive market has taken its toll as illustrated by cost cutting measures, reduced staff while diminishing the efficiency and effectiveness of claims management practices.

ES&P continues to remain focused as qualified partners to our clients by providing independent audits with professional experienced personnel focused on improving your bottom line.

For more information on Auditing Services, contact
Marie Schlichtig at 516-773-8653.