Risk Management Based Approach

INCHES'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

  • Underwriting
  • Claims

We, at INCHES, 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 learnt from handlings claims across insurers
  • Help senior 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
  • Underwriting Audit
  • Designing documents pertaining to medical process
    • STP cases
    • Medical underwriting cases
  • UW process audit (Post facto)
  • Claims Process Audit
  • Communication Audit (Repudiation letters etc)
  • Medical audit (Transaction) of claims
    • Concurrent
    • Retrospective (based on data available)
  • Audit of network medical establishments
  • Audit of appropriateness of treatment given (picks out under/ over treatment given)
  • Audit for billing abuse (of consumables)
  • Team INCHES, all medicos, well-versed in medical policy and terminology; with collective clinical expertise of 370+ years; team undergoes regular in-house training
  • In-house repository of:
    • 3500+ STGs
    • Huge knowledge repository
    • Ongoing in-house training