Health insurance has become an important part of our lives. However, it is important to ensure that there is accuracy and efficiency while these processes are being met. One crucial part of this process is the internal claim audit. Let’s understand the meaning of internal audit. We will also learn how it works or why it matters to a policyholder. Let’s dive in.
Plans start at just ₹21/day*.
We pay 100% of your hospital bills
From syringes to surgeries
No limit on hospital room rent
No compromises on recovery
An internal claim audit is a thorough check that is done internally within an insurance company. This is done to review health insurance claims before they are finally approved and paid out. The goal is to ensure that the claim is valid, the documents are in place, and the claim amount matches the policy terms.
Now that we have understood what is the meaning of internal audit, let’s understand the difference between internal and external audits.
What is the internal audit? These internal audits in auditing are done by the insurance company’s own team.
They are conducted by third-party firms or regulators outside the company. These audits happen less frequently.
Advantages of internal audits are not restricted to only the insurance companies but also for policyholders.
When the claims are analysed closely, mistakes, if any, are caught early. This ensures correct payouts.
If there are any suspicious claims or patterns, they can be easily noted. This protects honest customers and the company as well.
Though the audit takes some time, it avoids bigger delays that could happen if issues are found after payment.
Not all internal audit work is the same. Here are some common types.
These audits take place before the claim is paid out.
These are conducted after your claim is settled.
Occasionally, random claims are selected for review to maintain overall quality and discourage errors or fraud.
These audits concentrate on specific claim types or patterns.
Now that we know the internal audit meaning, are you wondering what actually happens during an internal audit? Here’s a simplified breakdown.
Though the importance of internal audits is understated, insurers face some challenges while conducting them. With thousands of claims every day, auditing every single one thoroughly is difficult. Understanding and verifying complex medical procedures and bills require skilled professionals.
Now that we know what internal auditing is, it is important to ensure that the right health insurance claims are processed. They are handled fairly, accurately and efficiently. If you are a policyholder, you should be aware of the fraud and mistakes. This can help you gain more confidence in the insurance provider.
1.7K Linkedin Followers 
Reviewed by Vaibhav Kumar Kaushik 
Acko Technology & Services Private Limited
#36/5, Hustlehub One East, Somasandrapalya, 27th Main Rd, Sector 2, HSR Layout, Bengaluru, Karnataka 560102
Products 
Company
Legal
Support
Car Insurance 
Bike Insurance
Health Insurance
Group Health Insurance
Travel Insurance
Life Insurance
