September 22, 2021

Reframe Claim “Audits” for a More Constructive Approach!

In Shakespeare’s play, Romeo and Juliet, the latter tells her loverboy, “A rose by any other name would smell as sweet ..”


            Words matter.  That is true not only in courtship, but in claim audits. 

            Like it or not, fair or unfair, the word “audit” has a punitive, pejorative connotation that is negative.  If you want to do an audit, tell the TPA or claim unit that you want to do a “claim review.”  Others call it a “statistical claim analysis.”  This sounds more benign and less adversarial than “audit.”  Careful word choice may help dissolve resistance and foster more  cooperation.  No one should care what you call it as long as you follow best practices.

            Sadly, the word audit evokes defensiveness and may trigger that reaction.

            When you go for an annual physical checkup, does your doctor say that he or she is conducting a “health audit”? No, but that’s basically what they’re doing.

            When you visit your dentist routinely, does he or she tell you that they are doing a “tooth/mouth audit”? No, even though you could say that’s exactly what it is when they lecture you for the 18th time on why you should floss six times a day.

            Word choice matters.

            With claim audits, tis’ probably better to give than to receive. 

            If you’re the one getting an audit, try to frame the exercise differently.

            If you are receiving an audit, try to view the exercise as an opportunity to improve claim operations. Get beyond the often pejorative connotation that the word audit has.

            No doubt, audits are about as welcome as an involuntary colonoscopy … often leaving you feel like you’ve been equally reamed out. They are a distraction and an occasional drag on productivity.

            Nevertheless, they are a necessary evil and maybe even not evil if you can reframe the exercise as one that can spotlight opportunities to improve your claims handling and claim operation.

            An improvement is one word that we all can agree that we like!

Question:  What ways have YOU found to make claim audits go smoother? 


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