Deployment of 4Audit – Claims Management Quality Assurance Tool

Challenges

The Client’s Quality Assurance Team had been facing multiple challenges with their claims audit function:

  1. Existing excel solution was old, difficult to maintain, inflexible and problematic to use
  2. QA team needed a tool that was parameter driven so they were not locked into one audit approach, but instead could be flexible enough to change with the department’s changing audit requirements
  3. Audit process needed to be consistent, objective, and accurate
  4. Audit results needed to be visible at different levels depending on the role within the claims department
  5. Audit process needed to reveal areas for improvement and target area for training
  6. The effectiveness of training sessions needed to be evaluated

The Solution

4Audit is an end-to-end claims auditing tool, architectured to support the business and technical needs of the claims auditing department.

4Audit is designed to make the audit process more efficient, objective, and accountable. Auditors become more productive and the audit process is more beneficial to the auditees, as it is standardized and executed consistently, and all of the results are visible.

The feedback and findings from an effective auditing program provided insights as to where process improvements can be made and training and development opportunities lie. Focusing resources on developing and maintaining solid claim-handling and oversight processes, along with a strong and effective audit program, allowed the claim department to outperform.

Results

At the time of writing the case study, the results have not been quantified. However, the clients’ team feels confident that they would be able to achieve

  • A significant reduction of manual audit steps resulting in corresponding efficiency gains of upto 30%
  • Increased employee motivation due to objective scoring methodology and complete visibility
  • Insightful reports giving a better control over the process
  • Continuous process improvement opportunities

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