Market Conduct Examinations

Changes in the US health care system are calling for strong accountability towards policyholders, shareholders, and employees . Consumer empowerment and protection are featured as a mandatory part of best practices. Market conduct examination reports and conflict of interest surveys have acquired greater importance, and require rigorous planning, elaborate information collection, and detailed data analysis and reporting.

The compliance unit’s major area of responsibility is to ensure positive outcomes from market conduct exams that are conducted to determine how the company operates in the market. The exam covers aspects - such as sales practices, advertising materials, marketing, policyholder services, underwriting, rating, and claims handling practices.

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MetricStream Market Conduct Examination Management Software Solution

The MetricStream solution provides comprehensive capabilities for identifying governing regulations, providing complete compliance evidence, tracking the evidence status, and managing policies and standard procedures associated with regulator audits. The solution first allows personnel to access the examination notification received from the regulator. Based on the pre-audit questionnaire, the staff can assign tasks and obtain documents and information with due date. They can also track open assignments.

The solution supports documentation and preliminary reporting. It allows personnel to consolidate the records and send it to the regulator for a preliminary review. Certain sections of the report can be flagged as confidential and shared only with appropriate users. The system automatically generates mandatory reports in prescribed formats and layouts.

The solution also supports post-examination stipulation and corrective action implementation. It allows the company's personnel to upload and route certain portions of it to appropriate members for reviews based on the entities that are impacted. The system provides the capability to configure and execute certifications based on pre-defined templates and schedules for designated executives. The result of the follow-up task is routed back to the appropriate executives for approval and final closure of the case.

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