Claims Bordereaux
Every TPA claims bordereau checked against authority and reserves, with leakage flagged each month.
Why it matters
Claims bordereaux arrive late and in many layouts; carriers review a quarterly sample, so payments above authority, duplicates and stale reserves are found long after the money has gone.
How the solution handles it
Six agents read each claims bordereau, check every line against the TPA’s settlement authority, track reserve movement, catch duplicate payments and large losses that should have been notified, and draft a cited oversight pack. The claims oversight manager decides what to escalate and signs.
How a claims bordereau moves
Six specialist agents read and check every TPA claims bordereau; a claims oversight manager decides each escalation.
What it reads, and what it hands back.
What goes in
- Monthly claims bordereau
- Claims authority agreement
- Large-loss advices
- Payment and reserve ledgers
What comes out
- TPA scorecard
- Escalation log with source rows
- Reserve movement report
- Signed oversight pack
Who uses it
The difference, in numbers.
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
every claim line
Lloyd’s requires coverholders and TPAs to report claims data to underwriters · “Target” = design goal, measured in the live solution · agents = the live solution’s configuration
6 specialist agents. One person decides.
More in this division.
Every monthly bordereau checked row by row against the binder, with breaches flagged before the month closes.
Authority AuditCoverholder audits that test every bound risk against the binder, with a cited draft report in days.
Coverholder OnboardingNew MGAs and coverholders vetted against your standard in days, every answer tied to its evidence.
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