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I am a Senior Quality Assurance associate at an insurance processing center. I would like to find out more about new ways to conduct effective audits on processes of operations.

I am a Senior Quality Assurance associate at an insurance processing center. I would like to find out more about new ways to conduct effective audits on processes of operations.

5/31/2008

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Question
I am a Senior Quality Assurance associate at an insurance processing center. I would like to find out more about new ways to conduct effective audits on processes of operations.

Answer

The purpose of any quality assurance activity is to ensure that the staff is doing what they are supposed to do – following all documented procedures, and delivering high-quality work. To effectively audit any task, you need to know how that task is performed. The best auditors are familiar with the operations that they are evaluating. Here are some auditing best practices.

  1. Advise department management that you are conducting the audit, unless there are specific reasons for them not to be aware that they are being evaluated.
  2. Obtain an overview of department functions to gain a high-level understanding of the activities that you are auditing.
  3. Obtain all documented procedures for the department that you are auditing.
  4. Gain access to all systems that will be needed to conduct an audit for the department.
  5. Learn how to access the data that you need on the system.
  6. Based on your organization’s guidelines, determine exactly what you are going to be auditing. For example, if the department processes insurance claims, you will need to audit a predetermined number. Most auditors use statistics to determine how many claims need to be audited. It’s possible that the department handles many types of claims; in this case, you may decide to audit each of the different types separately.
  7. Review relevant documents to ensure that they comply with departmental guidelines.
  8. Identify and document cases where processes have not been handled properly.
  9. Determine the underlying reason for any mishandled activity – whether ignorance or inappropriate actions. This will require working with department management. If inappropriate or illegal activities are suspected, follow your internal guidelines for handling these issues.
  10. Provide detailed feedback to department management about the audit. While this may not be your primary goal, the audit can provide great training insights to the department.
  11. Write up your auditing report.
  12. Share the report with department management.

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