At Criterion Claim Solutions we understand that you value expertise, experience, and professionalism. You need a TPA that will help you achieve profitability while ensuring that your claims are handled skillfully and that your standards are met. To achieve these results and meet your needs, we offer the following services:
Claims can be reported by phone, fax, e-mail, or online. We provide 24/7 claim response for emergency situations. Additionally, new reported losses receive immediate attention and are treated as a priority.
Our claim information systems provide real time data, updated as soon as it is entered. We capture all standard claim data elements, as well as customized fields that may be unique to your program. Because you need information immediately, we can provide client access to your claim data online at any time. Data reports should meet your specific needs, and we offer various standard formats or custom designed reports, including historic “as of” reports. And all reports can be scheduled to run and be provided when you need them.
We identify any responsible parties and aggressively pursue subrogation sources for maximum recovery. Collection of salvage, subrogation, deductible, and SIR funds is a primary function for our dedicated claim recovery specialists…not just an afterthought.
We maintain a national network of attorneys, including specialists in transportation litigation and coverage issues. We will put together and direct a litigation plan for each case in order to control costs and positively affect outcomes.
Loss Fund Management
In order to meet your needs regarding payment of losses and expenses, we offer various options. We can provide payment recommendations to allow you to issue payments directly, issue payments on your behalf, or maintain a direct loss fund account – including all balancing and reconciliation of funds.
Fraud / SIU
We can work directly with your SIU staff or designated service providers, or we can identify resources to provide those services. We will identify, investigate, and report suspicious or fraudulent claim activity to assure that unwarranted claims are not paid and that the required information is captured for government mandated reporting.
Internal Quality Control
Assuring that all of our designated procedures are followed on a company-wide basis is integral to our service commitment. Therefore, we implement an internal quality control process that includes direct supervision, routine file reviews, specified authority levels, and regularly scheduled random file audits.
Our clients routinely conduct claim file reviews, either in person or via remote electronic access. We also welcome reviews by reinsurers, financial control audits, and others.