How it works
From claim file to provable consistency
Follow how a file moves through the review: from the moment it arrives, on any line and any mandate, to a documented recommendation your clients can rely on.
01 · The bar
Judged on consistency, and on proving it
An insurer that outsources claims still owns the outcome. So the questions they put to you are always the same: are the decisions on their book consistent, and can you show it. A good answer in a review meeting is not enough. The proof has to sit in the files.
The same proof is what the Financial Ombudsman Service looks for when a decision is referred: reasoning documented at the time, not reconstructed afterwards.
02 · The volume problem
Consistency by hand does not scale
Keeping documentation consistent by hand, across lines, handlers and client mandates, gets harder with every point of growth. The moments that expose the gap are predictable.
Multi-line mandates
Each client brings its own lines, wordings and expectations. Consistency has to hold across all of them at once.
Client audits & evidence requests
An insurer asks how a set of decisions was reached. The answer has to come from the files, not from memory.
Ombudsman referrals
A referred decision is judged on what was documented at the time. Your client's name is on the outcome.
Peaks & surge volume
A storm, an event, a new mandate going live. Volume doubles; the documentation standard is not allowed to slip.
03 · How the review works
Every claim file read end-to-end. Built to plug in.
A claim file arrives
From any mandate, on any line, at any length. The review does not change with the client whose book it belongs to.
Every page is read
The system reads the file end-to-end, regardless of line. The timeline is structured and the findings are set against the policy wording.
Contradictions are flagged
Anything that does not line up is surfaced: dates that conflict, a report that contradicts a statement, a decision out of step with similar files on the same book.
The rationale is drafted
A fair-value rationale for the recommendation, held to the same standard on every line and every mandate, written to be read later.
A lawyer reviews and signs off
Nothing goes back as machine output. A lawyer works through the file, the flags and the rationale, and signs off.
The recommendation goes back to your handlers
Inside your existing workflow, not around it. Documented and ready whenever a client or the Ombudsman asks.
04 · What you get
Consistency that survives the question
Every file goes back with a structured, lawyer-signed recommendation behind it, held to the same standard on every line and every mandate. When a client audits or a decision is referred, the evidence is already in the file. And full-depth review finds what sampling cannot. For one of our clients, moving from partial to full review surfaced 2% of previously-approved decisions that should not have gone the way they did, worth over $11M a year.
