This session will describe how medical claims are processed by self-insured plans. We will explain the auditor's responsibility with auditing self-insured claims in a financial statement audit; and clarify the difference between a medical claims review and a financial statement audit. The session will also discuss best practices for testing these types of claims, including possible uses of data analytics; specifically on auditing claims and risk assessment.
Reconstruct the life-cycle of a claim.
Categorize the different purposes for each type of audit (i.e., medical claims audit, financial statement audit).
Assess risk assessment for a self-insured Health and Welfare Plan audit.
Evaluate the auditor’s responsibility when auditing a self-insured health and welfare plan and describe the difference between a medical claims audit and a financial statement audit, and where the findings in a claims audit can help the financial statement auditor.