Claims auditing is crucial for captive carriers, MGAs, Risk Retention Groups, and specialty insurance carriers utilizing TPAs, as it ensures that claims are processed accurately, identifies potential inefficiencies or compliance issues, and maintains financial integrity and trust between the carriers and their policyholders. Many smaller carriers and Risk Retention Groups lack a dedicated internal claims auditing team, and as a result face issues with inconsistent claims handling, claim overpayment, potential compliance lapses, and have a difficult time identifying opportunities for improvement.

Interwoven’s comprehensive claims auditing services deliver an impartial and detailed review of claims handling, empowering carriers and their third-party vendors to uncover and act on opportunities for improvement. This proactive approach not only enhances the quality of claims services but also ensures that carriers consistently excel in meeting and exceeding the needs of their members.

• Interwoven conducts a detailed audit of the carrier’s claims files, payment accuracy, and regulatory compliance.
• Identifies inefficiencies in the claims handling process and potential areas for cost recovery.
• Provides actionable recommendations for improving claims management practices.
• Offers regular updates and feedback on audit findings and compliance status.
• Assists with the implementation of audit recommendations and ongoing adherence to best practices.

• Enhanced Accuracy and Compliance
  • The carrier benefits from accurate claims processing and strong adherence to regulatory standards, reducing the risk of errors and non-compliance.
• Identification of Inefficiencies
  • Interwoven’s audit highlights inefficiencies and areas where claims leakage can be addressed, leading to more streamlined operations.
• Improved Financial Management
  • By uncovering financial discrepancies and potential savings, the carrier can better manage its financial resources and maintain adequate reserves.
• Strengthened Trust and Transparency
  • Regular independent audits enhance the carrier’s credibility and trust with policyholders, demonstrating a commitment to fair and transparent claims handling.
• Data-Driven Insights and Continuous Improvement
  • Detailed reporting and expert insights enable the carrier to continuously refine its claims processes, ensuring ongoing improvements and high service standards.