Audit
Insurance, be it life or health, is largely based on deep insights on commonly occurring ailments, their risk factors, their progression, morbidity caused and how they lead to the terminal event - either hospitalization or death!
Hundreds of Crores are paid out as insurance claims each year and even a minuscule 1% if fraudulent, not only means huge tangible loss to the insurer but also leads to major intangible loss, in fact the fraudster now gets bolder and plans something bigger.
Medical and /or Clinical audit of settled claims is a mandatory step not only to curb losses but also to create benchmark for future diligence and process refinement.
