Qualitative Claim Auditing refers to a review of claim files to explore the level of claims handling adequacy. The best way to accomplish a qualitative audit is by comparing the file handling to the claims manual using a scoring sheet. A qualitative claim audit can be performed internally or by an outside auditor and can be invaluable in helping to cut costs and improve efficiency in a claims office.
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Two Prescription Networks That I Use and One Helpful One From the Past Prescription networks, (also known as pharmacy networks) have evolved over the years
2012 – 2022 Workers Comp Prescription Analytics Shows Reversing Trend The Workers Comp Prescription Analytics Report released by NCCI today shows that prescription costs per
2023 WCRI Conference – Top 10 Things I Learned – Part 2 of 2 The 2023 WCRI Conference Top 10 (Part 1) can be found
WCRI 2023 Conference – So Much Learned In The Grand Canyon State The WCRI 2023 Conference’s theme this year was Disruption, Resilience, and Evolution. As
Workers Comp Premium Audit Process Changed Forever Oh no – another pandemic effect article. Yes, we have seen too many over the last 36 months.
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Term Of The Day – Wage Statement A wage statement is a necessary yet tedious part of paying a WC claim properly. The injured employee’s compensation
James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.
James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.
James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.
LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.
James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.
He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.
James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:
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