Medical Claim Audit, Claims Auditor

Medical Claim Audit, Claims Auditor

KBM developed the Claim Management Quality Assurance Audit in 1994 to provide our self-insured clients the ability to evaluate the performance of TPA’s hired to process their health and/or Workers’ Compensation plan claims.  Our Audit differs from a traditional financial audit in that it evaluates the complete administrative process as it relates to the benefit plan.  A claim is followed from the time it’s received by the administrator to the time payment or denial is generated.

KBM has audited the majority of regional and national claim payers; as a result of our broad client base we are familiar with the numerous software systems each organization employs and the limitations associated with them. Our Audit Department is staffed by seasoned medical claims professionals, many of whom have worked for the insurance carriers being audited. KBM utilizes a detailed questionnaire, personal interviews, system access, statistical analysis and claim management expertise to develop a report that details claim processes and vendor management.

The audit is designed to provide our clients an assurance that their benefit administrator is performing at the level committed to in the contractual agreement.  If claim administration falls below industry standards, recommendations are made to improve performance or seek alternative TPA’s.   The KBM Audit Department is staffed by those previously employed in the medical claims payment field; their “inside” knowledge, in conjunction with on-going training, makes this service a formidable tool in the management of a benefit plan.

We offer our Auditing services to our existing clients as well as a stand-alone, a-la-carte service to all self-insured entities.

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