Process Capabilities - Claims Audit

Current Engagement

The Claims Audit process is the principal component in the Healthcare Insurance Cost Containment domain. The process is involved in identifying potential overpayments & recovering the overpayments from the Providers, on behalf of the Payers.

InfiniteBPO current engagement in the Claims Audit process is for the largest Cost Containment Company in the United States. The assignment involves InfiniteBPO to identify potential overpayments by reviewing, analyzing & researching the claims of one of the largest Insurance Companies in the USA.

The success rate of the current engagement has been exponential with a 700% growth in the overpayments identified over the last 18 months, with the existing team.

Process Capabilities

The current assignment for InfiniteBPO involves the identification of overpayments. The process is capable of handling the following areas

• Overpayment recoveries from the Providers
• Credit Balancing
• Medical Bill Review