success story

Intelligent Audit Platform developed for a multinational health insurance company

Supporting audit processes across five different lines of business and various functional areas

Financial and procedural auditing is a critical business function of health insurance organizations. Audits are performed on various entities, including claims, prior authorizations, benefits, customer service, and appeals across multiple lines of business. These audit practices must often be more standard, cumbersome, time-consuming, and error-prone.

Organizations need a single platform that handles all the auditing issues and ensures a seamless process. Virtusa stepped up to cater to this need; our Intelligent Audit Platform (IAP) serves as a boon to health insurance organizations by taking care of all the audit requisites and more.

Let us take you through how Virtusa’s IAP helped this national payer with its audit challenges.

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The Challenge

High turnaround time

  • Manual sampling, auditing, and scoring are time-consuming processes hence high turnaround time 
  • The absence of Service level agreements, reminders, and automated escalations also results in delays

Manual sampling

  • Manual audit sampling leads to operational inefficiencies
  • Effort-intensive tasks to gather the population for the manual sampling for every audit run

Financial implications

  • Low scores (error in the calculation) may result in potential brand damage, followed by fines and penalties for non-compliance 
  • Process bottlenecks leading to higher costs 
  • Increased count of resources required to perform the audit process leading to higher costs

Productivity impacts

  • Inconsistent work distribution among auditors
  • Communication through emails makes it difficult to track
  • Actions taken while auditing are not recorded and cannot help in assessing inefficacies

Data security

  • Due to manual intervention, risk of data security and unauthorized access to personally identifiable and protected health information

Disparate systems

  • Documents from multiple systems are manually accessed for auditing purposes which is a time-consuming task
The Solution

Virtusa's IAP solved the multitude of audit challenges faced by the organization. That is right; all it took was one platform to reap incredible results.

Our IAP comes with a reusable architecture that supports specialized implementation. The solution integrates with internal/external systems providing holistic and quick access to audit data. With automated and manual sampling, intuitive audit workflows, and well-defined defect and correction workflows – IAP makes for a rich suit for audit services. These features helped the national payer obliterate all the challenges and function with a flawless audit process.

Our solution also handled security and escalation management for this health insurance organization.

Intelligent audit platform developed for a multinational insurance company
The Benefit

The solution offers benefits that set Virtusa apart from the rest:

  • Outreach management
  • Closed loop audits
  • Internal collaboration between IAP users
  • Knowledge database
  • Scoring and reporting
  • Record productivity-related information
  • Create user portals and corresponding gadgets for all the personas
Connecting Patients, Payers, and Providers in Healthcare
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