Vision of Service
Empower and support Life and Health Insurance organizations through experiential training, intellectual inputs and medically apt cum legally sound opinions.

X-CLAIM Audit

Risk Management Based Approach

X-CLAIM's Audit Model is a risk management based approach to ensure client's audit resources are focused on the business units with the greatest risks viz claims, customer satisfaction across functions and service quality of vendors.

We, at X-CLAIM, focus on auditing issues, not people; on developing solutions, not placing blame. Issues are discussed as identified and we develop action plans in collaboration with management. The draft audit report comes along with the action plans and approach for addressing issues.

This approach is vitally useful and allows us to:

  • Share with our clients what we have learned from handlings claims across insurers
  • Help management address risk and strengthen internal controls
  • Constantly improve our quality because of the insight and wisdom we gain from our partnership with insurers.

Types of audit

  • Claims Process Audit
  • Communication Audit
  • Medical audit (Transaction) of settled claims
    • Concurrent
    • Retrospective (based on data available)
  • Random survey for customer experience
  • Audit of medical establishment empanelment Process
  • Audit of appropriateness of treatment given (picks out under/ over treatment given)

Why X-CLAIM?

  • Team X-CLAIM, all medicos, well-versed in medical policy and terminology; undergo regular in-house training
  • In-house repository of 300 disease templates and 100 appropriateness protocols.