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When Our Capacity Provider Audits Our Binder, Why Does Gathering the Evidence Take Weeks?

Insurtech MGAs spend weeks gathering files for capacity provider audits. We build a policy and claims file record so audit samples are quick to pull.

Updated 3 min readBy SpiderHunts Technologies

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Quick answer — TL;DR

Binder audits take weeks because the evidence for each sampled policy or claim is spread across the policy system, email, underwriting notes and the claims administrator. We build a file record that links everything about each policy and claim as it happens, and an audit screen that produces a complete file for each sampled item, with gaps flagged before the auditor sees them.

The audit notice arrives

Your capacity provider schedules its audit of the business you write under your binding authority. They send a list of sampled policies and claims and ask for the file on each: the proposal, rating, underwriting decisions and referrals, documents issued, mid-term changes, payments, and for claims, notification, handling notes, reserves and settlement.

Your team starts gathering. Rating details come from the policy system. Referral decisions are in emails. Some underwriting notes are in a shared drive. Claims files are with the administrator, who has to be asked. Each file is assembled by hand into a folder, and someone checks it against the auditor's list. The operations and underwriting teams do little else for weeks.

Why the file is never in one place

Each system stores its part well. The file, as an auditor sees it, crosses all of them.

  • Referral and underwriting decisions are made in email or chat.
  • Documents issued are stored in one place, changes in another.
  • Claims files are held by a third-party administrator.
  • Authority limits are not recorded against each decision.
  • There is no view of what a complete file looks like, so gaps are found late.

What your auditor needs and how your binder should be operated is set by your agreement and your capacity provider. Our part is making the evidence of what you did complete and quick to produce.

What a slow audit costs

Weeks of senior time goes into assembly instead of running the business. Gaps found during the audit, even if the underlying work was done properly, look like control weaknesses. Findings can affect your relationship with the capacity provider and the terms of future capacity. And the same scramble repeats at the next audit.

A file record built as you go

What we build links everything about each policy and claim in one record, as it happens.

  1. Each policy has a file record that links its quote, rating version, answers, documents, changes and payments from your systems automatically.
  2. Referral and underwriting decisions are captured from your referral queue with the underwriter, their authority level and the reason.
  3. Emails about a policy can be filed to its record from the inbox with one action, or automatically where a reference is present.
  4. Claims files from your administrator are linked by claim reference, with notes and reserve history loaded from their data or requested through their API.
  5. A definition of a complete file, agreed with you, is checked against each record, and gaps are flagged as they appear.
  6. An audit screen takes the auditor's sample list and produces a complete, indexed file for each item, as a folder or a single PDF.
File partCaptured fromChecked for
Proposal and answersQuote journey or broker portalPresent
RatingRating service version and factorsMatches premium charged
Referral decisionReferral queueDecision, underwriter and authority level
Documents issuedDocument serviceVersions match policy dates
Claims fileAdministrator data and notesNotification, reserves, settlement

The next audit

The sample list arrives and the files are produced from the audit screen, not assembled by hand. Your team reviews them, adds context where needed and sends them. Gaps were flagged during the year and dealt with then. The auditor's questions are about the business, not about finding documents.

Is audit preparation like this for you?

  • Audit files are assembled by hand from several systems.
  • Referral decisions are only in emails.
  • Claims files have to be requested from the administrator.
  • Gaps are found during the audit, not before.
  • The team is tied up for weeks each audit.

FAQ

Frequently asked questions

The questions readers ask us after this guide.

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Can you guarantee a clean audit?

No. We make evidence complete and quick to produce. The outcome depends on how the business was run and what the auditor finds.

Can it include files from before the build?

Partly. We link what your systems still hold and flag where older files are thinner.

Does our administrator need to change anything?

Ideally they send data regularly or offer an API. If not, requests for claims files can be tracked in the record.

Where is the data stored?

In your own cloud environment, with access by role.

What drives the cost?

The number of source systems, the definition of a complete file, and how much history to link.

Keep reading

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