Maker-Checker in Reinsurance Claims: Controls That Hold
On this page
- Maker-Checker in Reinsurance Claims: Building Approval Controls That Auditors Trust
- Key Takeaways
- What Is Maker-Checker in Reinsurance Claims?
- Why Do Reinsurance Claims Need Maker-Checker Controls?
- What Should a Claims Authority Matrix Contain?
- What Should the Checker Actually Check?
- Where Do Maker-Checker Controls Fail?
- How Should Maker-Checker Handle Bulk Claims?
- Will Maker-Checker Slow Claims Down?
- How Do You Build a Maker-Checker Control Step by Step?
- What Evidence Do Auditors Trust?
- Where Does Automation Help?
- How Does Maker-Checker Work With Delegated or Outsourced Claims?
- Which Metrics Show Maker-Checker Is Working?
- What Should Chief Claims Officers Do Next?
- Key Terms
- Sources
- Frequently Asked Questions
Maker-Checker in Reinsurance Claims: Building Approval Controls That Auditors Trust
Last reviewed: November 2026
Every claims team says it has four-eyes review. Auditors ask a harder question: can you prove the second pair of eyes looked, every time?
Short answer: Maker-checker in reinsurance claims separates the person who prepares a claim decision from the person who approves it, within documented authority limits. Auditors trust it when the system enforces the split and keeps timestamped evidence for every claim and adjustment.
Key Takeaways
- Separate the roles in the system. A policy that one user can bypass is not a control.
- Limit by claim, not just by movement. Small adjustments can add up past an approver's authority.
- Define what the checker checks. Without a standard, review becomes a click.
- Software routes, people decide. The workflow enforces authority, but claims professionals make the call.
What Is Maker-Checker in Reinsurance Claims?
Maker-checker in reinsurance claims is a two-person control on claim decisions. The maker prepares the facts, calculation and recommendation, and the checker independently reviews and approves them.
The checker must be able to say no. A checker who only confirms the maker's screen adds delay, not control.
Independence also means the checker should not report to the maker. Where a claims team is small, route the check to another team or to leadership.
Why Do Reinsurance Claims Need Maker-Checker Controls?
Reinsurance claims need maker-checker controls because one decision can be large and hard to reverse. It also drives retro recoveries, reserves and the cedent relationship.
The IAIS expects segregation of duties and policies on who can commit an insurer, and for what amounts. It cites the practice that key decisions are taken by at least two persons.
Lloyd's claims management principle also expects robust governance and oversight to monitor claims outcomes. Maker-checker is the most visible part of that governance.
What Should a Claims Authority Matrix Contain?
A claims authority matrix should set who can approve what, up to which amount, and when to escalate. This illustrative matrix shows a common shape.
| Claim or action | Maker | Checker | Escalation |
|---|---|---|---|
| Standard claim up to 250,000 | Claims analyst | Claims manager | None |
| Standard claim 250,000 to 1,000,000 | Claims analyst | Claims manager | Leadership approval |
| Claim above 1,000,000 | Claims analyst | Claims manager | Leadership plus a second senior approver |
| Ex gratia payment, any amount | Claims analyst | Claims manager | Leadership approval |
| Disputed coverage or treaty interpretation | Claims analyst | Claims manager | Leadership, with legal input |
| Adjustment to a decided claim | Claims analyst | Claims manager | Based on cumulative claim value |
Set your own amounts by line and currency. The structure matters more than the thresholds.
Why test authority on cumulative value?
Authority should be tested on cumulative value because adjustments can creep past a limit. Three small increases can turn a manager-level claim into a leadership-level one.
If each adjustment is tested alone, none breaches the limit. Testing the running total closes that gap.
What Should the Checker Actually Check?
The checker should test the decision against a written standard, not just the arithmetic. A short checklist keeps reviews consistent across checkers.
- Treaty and period. The treaty was in force, and the claim falls within its period and basis.
- Eligibility. The life or risk was covered, for example the member is in the scheme census.
- Quantum. The benefit or loss calculation follows policy and treaty terms.
- Retention and shares. Cedent retention, reinsurer share and retro are applied correctly.
- Exclusions and conditions. No exclusion applies, or its application is documented.
- Documents. Required documents for the claim type and cause are on file.
- Authority. The decision sits within the checker's limit, or is escalated.
The checker records the outcome against each item. That record is what auditors later sample.
Where Do Maker-Checker Controls Fail?
Maker-checker controls fail when the split exists in policy but not in practice. These failures are common, and each one is detectable.
| Failure | Why it matters | How to detect it |
|---|---|---|
| Self-approval | One person commits the reinsurer alone | System rule blocks it, and logs attempts |
| Checker edits, then approves | The checker becomes the maker | Any edit returns the claim to a new checker |
| Approval by email | No reliable link to the claim | Count approvals recorded outside the workflow |
| Per-movement limits only | Adjustments bypass authority | Test cumulative value on every change |
| Shared logins | Nobody can prove who approved | Periodic access reviews |
| Undocumented delegation | Authority is borrowed informally | Time-limited, recorded delegations |
The second row is often missed. A checker who fixes the calculation and approves it has reviewed their own work.
How Should Maker-Checker Handle Bulk Claims?
Maker-checker should treat each claim in a bulk file as its own decision. Group Life and Credit Life cedents often send many claims in one spreadsheet.
Row-level validation catches format and data errors first. It checks the file, but it does not replace the checker's review of each claim.
Batch approval can work for low-value claims within a defined limit. Anything above that limit, or failing a rule, should leave the batch for individual review.
Will Maker-Checker Slow Claims Down?
Maker-checker slows claims down only when every claim waits for the same senior approver. A tiered matrix keeps most claims at the lowest sensible level.
Route claims automatically to an eligible checker, and track approval time by tier. Delays then show up as a metric, not as a cedent complaint.
Fast and controlled are not opposites. Clear limits usually speed decisions, because nobody has to ask who may approve.
How Do You Build a Maker-Checker Control Step by Step?
You build a maker-checker control by defining authority, enforcing roles and keeping evidence by default. It works in six steps.
- Write the authority matrix. Set limits by claim value, type and special case, approved at senior level.
- Define the review standard. Publish the checker's checklist and what counts as a return.
- Enforce roles in the system. Block self-approval and route each claim to an eligible checker.
- Apply the matrix to adjustments. Test both the adjustment and the cumulative claim value.
- Keep evidence by default. Timestamp every action, and link approvals and reasons to the claim.
- Monitor and test. Report on returns, overrides and escalations, and have internal audit sample regularly.
Step six turns a static control into a living one. The IAIS also expects periodic testing by objective parties, such as internal or external auditors.
What Evidence Do Auditors Trust?
Auditors trust evidence that the system created at the time, not evidence assembled afterwards. Screenshots and forwarded emails carry little weight.
- A timestamped record of who prepared, who checked and who escalated.
- The authority limit that applied to each approver at the time.
- The checker's recorded outcome against the review standard.
- Every adjustment as a separate movement, with its own approval.
- Access reviews showing roles matched job responsibilities.
Our guide to the reinsurance audit trail covers how this evidence fits the wider regulatory record.
Where Does Automation Help?
Automation helps by routing claims through configured authority and keeping the evidence automatically. It does not make the claim decision.
The Reinsurance Claim Core Platform is built for Group Life and Credit Life reinsurance claims. Its authority matrix sets approval limits and decides when escalation is required.
Claims analysts act as maker and claim managers as checker. Claims above the configured authority level move to leadership.
Changes to decided claims become controlled adjustments, without overwriting the original position. Authority configuration covers claims, adjustments and member requests.
Claims professionals and authorised decision-makers remain responsible for final claim decisions. The platform enforces the route, and people own the judgement.
How Does Maker-Checker Work With Delegated or Outsourced Claims?
Maker-checker still applies when claims handling is delegated or outsourced. The reinsurer must see that the control operated, not just that it was promised.
Periodic audits of delegated authorities miss problems between visits. See continuous control monitoring for delegated claims authorities.
Outsourcing the work does not outsource the accountability. Our guide to outsourcing the claims function explains what to retain.
Which Metrics Show Maker-Checker Is Working?
The best metrics show whether checkers really review, and whether authority holds. Review them monthly.
| Metric | What it tells you |
|---|---|
| Checker return rate | Near zero suggests rubber-stamping |
| Median approval time on complex claims | Seconds suggest no real review |
| Adjustments after approval | Whether first decisions are right |
| Self-approval attempts blocked | Pressure on the control |
| Approvals recorded outside the workflow | Gaps in evidence |
| Escalations by reason | Whether the matrix fits real claims |
What Should Chief Claims Officers Do Next?
Chief claims officers should test their own control before the auditors do. These four actions take weeks, not months.
- Sample 20 recent claims and check who prepared, approved and escalated each.
- Apply authority limits to cumulative claim value, not single movements.
- Publish a checker standard with a recorded outcome for each item.
- Remove approval by email for any claim above the lowest limit.
Key Terms
- Maker: The person who prepares a claim decision and its supporting calculation.
- Checker: The independent person who reviews and approves or returns the decision.
- Authority matrix: A table of approval limits by role, value and claim type.
- Escalation: Routing a decision to a higher authority when it exceeds a limit.
- Segregation of duties: Splitting tasks so no single person controls a transaction end to end.
- Rubber-stamping: Approval without genuine independent review.
Sources
Frequently Asked Questions
What is maker-checker in reinsurance claims?
Maker-checker in reinsurance claims is a control where one person prepares a claim decision and a different person independently reviews and approves it. The maker assembles the facts and calculation, and the checker confirms them within a documented authority limit before the decision takes effect.
Why do reinsurance claims need maker-checker controls?
Reinsurance claims need maker-checker controls because individual claims can be large, depend on treaty interpretation and drive retro recoveries. A second, independent review reduces errors and conflicts of interest, and gives auditors evidence that no single person can commit the reinsurer alone.
What is a claims authority matrix?
A claims authority matrix is a table that sets which role can approve which claims, up to what amount and when escalation is required. A claims authority matrix usually considers claim value, claim type and special cases such as ex gratia payments or disputed coverage.
Should claim adjustments go through maker-checker?
Yes, claim adjustments should go through maker-checker, just like original decisions. Authority should be tested on the adjustment and on the claim's cumulative value, so a series of small changes cannot move a claim beyond the original approver's limit.
What do auditors test in a maker-checker control?
Auditors test whether a maker-checker control is well designed and whether it operated every time. They check that roles are separated, limits are documented and enforced, approvals are timestamped and linked to each claim, and exceptions were investigated.
What are the most common maker-checker failures in claims?
The most common maker-checker failures in claims are self-approval, rubber-stamp reviews, approvals by email outside the system, limits applied per movement instead of per claim, shared logins, and undocumented delegation during absences. Each one leaves the control existing only on paper.
How can reinsurers tell if checkers are rubber-stamping?
Reinsurers can spot rubber-stamping by tracking checker return rates, approval times and later corrections to approved claims. Near-zero returns, approvals in seconds on complex claims and frequent post-approval adjustments all suggest the checker is not reviewing independently.
Who owns maker-checker controls for reinsurance claims?
Maker-checker controls for reinsurance claims are owned by the chief claims officer, who sets authority limits and the review standard. Internal audit tests the control independently, and the board or a committee approves the overall authority framework.
Hitul Mistry
CEO, Insurnest
An InsurTech leader with more than a decade of experience across insurance and technology, focused on solving business problems with the help of technology. Has worked with brokers, insurance carriers, and reinsurance firms across the India, UAE, and US markets.
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