Operational Reviews

In addition to our traditional auditing reviews we provide more in depth Operational Audits which may involve data, financial and process mapping, and can include the following considerations:

  • Organizational and functional reviews including staff analysis, workflow, file support and assignment procedures

  • Review authority and reporting levels

  • Systems and data processing procedures along with a review of data accuracy

  • Our audits will reveal how well claims are documented, including claim payments and reserves

  • Analyze the current claims organization with respect to client service, cost reduction and claims delivery

  • Audit Medical bills to identify duplicates, state fee schedule compliance, and the over utilization of services

  • Review and analysis of Litigation Management procedures and results

  • Reconciliation of loss data to ensure financial accuracy, elimination of improper claims and incorrect charges

  • Review loss funding arrangements with TPAs

  • Analyze claim opening / closing activity to eliminate potential reserve redundancy

  • Review contracts to improve data supplied by the TPA, reduce service fees and loss fund escrow levels

  • Conduct operational and financial reviews of TPAs to ensure data integrity

  • Statistically benchmark each function of the claim handing process, including final settlement in order to provide an overall leakage assessment

We're Focused on Pragmatic Solutions and Results