Why Audit?
Regular audits are an opportunity for a company to develop, improve, strengthen and understand where greater customer service can be provided while minimising claims leakage. In a challenging economic climate, businesses have to make tough decisions to cut costs without reducing the service proposition to customers. Audits can help in this providing a regular process and positive influence in any successful business. Maintaining a regular internal audit programme can be difficult, especially in a fast paced expanding company. If you have no regular internal quality audit controls, we can assist in developing such a service. Even if you already have regular internal audit controls, external audits provide a benchmark with a greater level of objectivity. The auditor, not distracted by the day-to-day operations of the business, can focus on the job in hand and complement your existing business processes. Please contact us for further information.
Key Benefits
Some Previous Audit Findings
Some Previous Audit Findings
- Decisions are consistent, objective, accurate and fair to your customers
- Customer service delivery is in line with business objectives
- Processes and procedures are being adhered to and running smoothly, efficiently and effectively
- Best practice application can be objectively assessed
- Cost containment opportunities are assessed vs. achievement
- Decisions are consistent, objective, accurate and fair to your customers
- Customer service delivery is in line with business objectives
- Processes and procedures are being adhered to and running smoothly, efficiently and effectively
- Best practice application can be objectively assessed
- Cost containment opportunities are assessed vs. achievements identified
- Claims leakage/wastage/fraud are identified to reduce financial loss to the company
- Reserving is correct and well maintained to ensure ongoing loss projections are accurate
- Staff are empowered, are knowledgeable and are applying the company standards defined
- Claims data input is correct so management reporting provides an accurate reflection of claims statistics
- Assurance is provided to the shareholders
Some Previous Audit Findings
Some Previous Audit Findings
Some Previous Audit Findings
- Hospital over charging by £300.00 a night on a long-term admission
- Duplicate payments made in excess of £15,000
- Incorrect excess deductions leading to unnecessary claims leakage
- Incorrect declinatures leading to poor customer satisfaction
- Incorrect acceptance of excluded claims
- Inconsistency in assessment practices across claims team
- Incorre
- Hospital over charging by £300.00 a night on a long-term admission
- Duplicate payments made in excess of £15,000
- Incorrect excess deductions leading to unnecessary claims leakage
- Incorrect declinatures leading to poor customer satisfaction
- Incorrect acceptance of excluded claims
- Inconsistency in assessment practices across claims team
- Incorrect SLA reporting found
- Insurer unaware of actual TPA claims turnaround time and service delivery to the customer
- Inadequate reserving which impacted on loss projection reports
- Air ambulance organised for a walking patient who on arrival went home - a loss of US$35,000 against the claims experience
- Fraudulent claims, one leading to Interpol involvement
- Policyholder dual insured and no recovery instigated - leakage totalled US$33,000