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Claims Administration and Auditing

 Audit

 Data Management & Analysis

 Adjustment Services

 Legal Support Services

 Pharmacy Management

 Vendor Management

 Medical Case Management

 Medical Bill Review

 

Claims Administration and Auditing
 
 
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Audit

Our claim audits can provide you with assurance that your controls are working as designed.

We evaluate adherence to policies and procedures, expense management, recovery efforts, reserving, litigation strategy and plans, regulatory compliance, cross-functional communication and supervisory oversight. 

We also determine the adequacy of your controls to support data integrity such as management information reporting, key performance indicator reporting, manual processes, data interfaces and segregation of duties.

Our tests continuously evaluate your control environment and include:

  • diary management
  • reserve change analysis
  • payment authority
  • claim trending
  • minimal reserve review
  • legal expense payment trending
  • adjuster/supervisor profiling for file assignments and closure opportunities 
  • outstanding check review
  • payment address matching
  • vendor contract review