SIU audit tips

Many SIUs find it beneficial to conduct operations audits to measure open and closed work product against a set of standards. Audit results can affirm the validity of those standards, and they can point out instances when investigators complied with or deviated from those standards.

Here are some ideas to consider when setting up an SIU audit:

• Review each individual work group annually using a formatted process.
• Form audit teams that are consistent and objective by using home office personnel and rotating supervisors from other work groups.
• Use customer service objectives, since those are the best foundation for SIU standards (time to assign, time to respond, time to close, timely reporting).
• Supplement customer service objectives with technical objectives, including use of data, use of resources, and investigative techniques.
• Limit productivity measures to opened, closed, and pending. Since individual case resolution is a consequence of the investigation, it should not be part of the audit.
• Share the audit results on an individual and work group level to highlight achievement and identify areas of opportunity.
• Combine the audit procedure with both the “open file review” process and “closed file review” process to increase consistency in expectations and results.
• Leverage the audit results in the six-month and annual performance review process. Doing so can help advance the organization’s goals and mission.

As is the case in most procedure development, gaining input from senior claim management as well as the law, human resources, and internal audit departments is essential to formulate an audit program that will work best in your environment.