Risk & Compliance Use Cases

Claims Review Audit

Digitize your audits to retain 100% compliance with regulatory bodies with less cost

The Challenges

Insurance companies have government mandated claim review audits that must be completed on a monthly basis. Most companies struggle to complete these claim review audits in a timely manner as they face the challenge of managing multi-jurisdictional teams that conduct audits differently and lack the tools to provide managers with the ability to assign and track pending audits. In addition, the auditors themselves are tasked with low value, manual work like the re-keying of claim information, scoring each audit and then generating an audit findings report.

How Checkbox Solves Claim Review Audits

Challenges How does Checkbox address it?

Claim review audits are time consuming and can be manual and low value: re-keying claim information, manual audit scoring and manual report generation.

Checkbox streamlines this process by automatically capturing claim information for the auditor, dynamically scoring the audit based on pre-determined logic, and then automatically generating a bespoke report with all audit findings.

Due to the lack of standardization across multijurisdictional teams, different audit questions are being asked, inconsistent scoring is being used, and non-uniform reporting is being distributed to government regulators. This complicates the task of comparing cross-jurisdictional audit data.

Checkbox can create a single source of truth across multi-jurisdictional audits and utilize its decisioning and complex calculation engine to standardize scoring across all claim review audits.

The document generation engine creates a comprehensive, and standardized report for each audit. 

Multi-jurisdictional teams need to audit claims against different jurisdiction-based controls. This leads to the use of multiple ad-hoc tools like MS Excel for each jurisdiction, which complicates the ability to manage Claims Reviews at a program level.

Checkbox facilitates custom claim review audits, depending on the jurisdiction of a particular claim. This allows for multi-jurisdiction claim reviews within a central location where managers can also assign claims to specific staff, manage outstanding claim review audits, and draw insights.

Claim review audits involve a substantial amount of re-keying of information from various systems. This is both inefficient and can lead to human error while keying in data.

Checkbox integrates with 3rd party systems to automatically retrieve claim-specific data into claim review applications.

Key Features

Benefits

  • Enable faster audit turnaround time

    Claim related data is automatically retrieved from third party systems, and the audit scoring and report generation process is automated.

  • Understand audit trends to make data driven responses

    Standardizing audits, scoring and reports enable analytics to be drawn, even for cross-jurisdictional audits. In turn, companies can make data driven response and decrease regulatory breaches and fines.

  • View live analytics and status updates in a centralized dashboard

    Use Checkbox’s dashboard to view cross jurisdictional audit score comparisons, assign audits to particular staff members and check the progress of assigned audits and their completion statuses

  • Effortlessly re-assign work and send reminder notifications

    All audits can be accessed in the dashboard where the current assignee is displayed and changed. Automated notification emails can be set up to remind assignees.

Integrations

How Does Checkbox Automate This?

1. Bulk upload information into Checkbox

Checkbox’s no-code platform can retrieve claim data from enterprise systems, including CSV files, or insurance management systems. Manage your team’s workload by assigning claim review audits to different members of your team across multiple jurisdictions.

2. Assign claims to appropriate auditor

Claim review auditors can pick-up their assigned claims and answer a series of custom-tailored questions that are specific to their jurisdiction and claim, based on prior answers that they have already inputted.

3. Automatically calculate and assign an audit score to each claim

Checkbox will automatically score a claim review audit by using cross-jurisdictional standardised scoring criteria.

4. Generate a bespoke audit report

Checkbox automatically generates a bespoke report with a complete audit trail of all questions asked, defects identified, and high severity breaches that need to be escalated.

5. Store generated audit reports and export audit related data

Integrate with third party file repository systems to store the generated audit report for future reference. Integrate with third party business intelligence tools to push audit related data and run comprehensive analytics across the organisation.

6. Track and manage your audit team

View audit statuses, send reminders for auditors, or re-assign claims with Checkbox’s dashboard. Analyze high level trends and common controls that are causing poor audit results.

Get started with your digital transformation journey

See how Checkbox fits in with your organization by contacting us and requesting a free demo