Claims Oversight
Oversight that gives you control, clarity, and confidence.
Oversight that gives you control, clarity, and confidence.
At Tailored Claims, we help carriers, MGAs, and program partners build strong, defensible claims oversight frameworks.
Whether you are establishing an internal adjusting function or governing delegated partners, we collaborate with you to design oversight models that protect your business, your brand, and your regulatory standing.
Our role is to ensure your claims operation performs to standard — not just on paper, but in practice.
What We Deliver
Governance Frameworks
We help you define clear accountability across your claims ecosystem.
• Roles and responsibilities
• Escalation structures
• Oversight reporting lines
• Delegated authority controls
MI & SLA Design
We design performance measurement that actually drives behavior.
• Executive dashboards
• SLA definitions
• Quality assurance metrics
• Root-cause analysis
So leadership can make decisions with confidence.
Oversight of Delegated Partners
We provide independent monitoring of TPAs, MGAs, and service providers.
• File reviews and sampling
• Service consistency checks
• Process adherence
• Documentation standards
Giving you visibility without micromanagement.
Internal Adjusting Team Setup
For organizations building in-house capability.
We support:
• Operating model design
• Process documentation
• Oversight structures
• Reporting frameworks
So your internal team is audit-ready from day one.
Your Standards, Not Our Templates
Every organization has a unique control environment.
We calibrate our oversight models to your:
• Impact tolerances
• Management information (MI) thresholds
• SLA frameworks
• Audit cadence
• Complaint handling protocols
• Brand voice and service expectations
The result is a white-label oversight structure that feels internal, not outsourced.
This aligns with delegated authority expectations around claims and complaints handling as critical business services.
