Why Audit?

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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

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  • 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

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  • 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