Traversing the Claims Audit Trail

Virtually every property and casualty company has a claim audit process. In some cases, there is an internal unit, either full- or part-time, assigned to the task. In others, the audit function is managed by TPAs or consultants. Regardless of whether claim functions are reviewed in hard copy, electronically, on- or off-site or both, I have not yet seen or been involved in any program in which the company gets full value for the time and money it expends. Let’s start with the word audit. It is a negative word, especially to the auditee, and some companies will avoid its use at all costs, on the theory that if you call it quality control or performance management, the process will be more palatable and positive.