Engagements

How a claims application audit is scoped and closed

This page is the working description of an engagement with LogicFabric Grid Advisory. It is written for the claims manager or internal auditor who will sit with us, not for a procurement brochure.

What we need before the first file is opened

A written engagement letter names the batch: line of business, period, and whether we are looking at open applications, closed files, or a mix. It also names the question. “Are we overpaying motor own-damage applications from last quarter?” is a question. “Review claims” is not.

We agree a sampling method before we see outcomes. If the client wants every file above a ringgit threshold plus a random slice below it, that is written down. Changing the sample after the first exceptions appear is how an audit stops being an audit.

File access is usually a secure folder of PDFs or exports, with an index. We do not take an unsupervised login to a live claims system unless the letter says so, and even then we print or save the application papers we rely on so the working paper can be re-performed.

Person planning work with papers and a laptop

The sequence we keep to

1

Kick-off at the desk or online

We confirm the batch, the authority matrix we should test against, and the people who can answer file questions. If a site visit to Taman Sentosa or to your claims floor is useful, it is booked here, not improvised mid-sample.

2

File read and recalculation

Each sampled application gets a working paper: source figure, recast figure, papers seen, and exception class if any. We ask for missing invoices once, with a list, rather than in a drip of chats.

3

Exception discussion

Material items are walked with the handler or claims manager while the file is open. We would rather correct a misunderstanding in the room than print it as a finding that was never a finding.

4

Batch schedule and close

You receive the file papers, a schedule of exceptions, and a short letter on scope and limits. The closing meeting is part of the fee. After that, follow-up on individual files is a new instruction unless the letter already includes a re-test.

Fees, time, and what this is not

Fees are quoted in the engagement letter as a fixed fee for a defined batch, or as a daily rate with a cap. There is no online checkout. A retainer may be invoiced before the first file is opened; the refund notice explains what happens if the work is cancelled or cut short.

An engagement is not a subscription, not a software licence, and not a standing claims helpdesk. If you need a second pair of eyes on one high-value application, that is the pre-settlement review, scoped as its own letter.

Start with the batch you have