Cognizant Open Claims Audit

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Overview

Each year, a significant percent of property and casualty claim dollars are paid in error due to mistakes and other oversights made in the claim adjustment
process. Cognizant Open Claims Audit helps claims managers evaluate a claim prior to closure and reduce errors that could lead to financial losses for the carrier.
With Cognizant Open Claims Audit, carriers can shift from a post-payment sampling of claim files to a near real-time review of files. All files are pre-screened
against insurance industry best practices and carrier policies. By reviewing flagged files in near real-time, carriers can reduce financial leakage and have a comprehensive view of the actions necessary to reduce risk by driving process improvements over time.

Key Features

This Software as a Service (SaaS) ingests carrier claim data and segments the claims by their characteristics. It then applies data analytic techniques, such as
advanced rules management and natural language processing, to perform automated claim audits. The patent-pending system is designed to perform an
automated review of claims across eight dimensions recognized as best practices in accurate and timely claim settlement:
• Progress – meaningful and timely
• Engagement – demonstration of thought and judgment
• Activities – complete and on-time
• Documents – collected and requested
• Reconciliation – contradictory facts in file resolved
• Regulations – compliance with fair claims practices
• Vendors – appropriate engagement of third parties
• Oversight – requisite supervisor involvement in file

Key Benefits

  • Audit before closure - automatically review open claims in near real-time
  • Reduce leakage – avoid overpayments caused by human or process error
  • Reduce costs – Lessen reliance on expensive third party audits for leakage
  • Manage risk - prevent against both random and systemic errors
  • Improve the process – drive changes towards more consistent claim adjustment
  • Monitor the process – metric driven health checks of adjuster performance
  • Tune to your business – at your convenience, without reliance on IT support or disruption to current claims system/workflow

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