Market Conduct Examinations

With changes in the US health care system giving rise to strong accountability towards policyholders, shareholders and employees, consumer empowerment and protection featured as a mandatory part of best practices and market conduct examination reports and conflict of interest surveys acquired greater importance requiring rigorous planning , elaborate information collection and detailed data analysis and reporting.

A major area of responsibility of the compliance unit is to ensure positive outcomes from Market Conduct Exams conducted is to determine how the company operates in the market place covering - sales practices, advertising materials, marketing, policyholder services, underwriting, rating, claims handling practices. MetricStream system provides comprehensive capabilities for identifying the governing regulations, providing complete compliance evidence, tracking evidence status, policies, standard procedures associated with regulator audit. The solution allows appropriate staff to access the examination notification received from the regulator. Based on the pre-audit questionnaire, the staff is able to assign tasks and obtain documents and information with due dates and track open assignments.

The solution supports the documentation and preliminary reporting. The staff is able to consolidate the records and send for regulator's 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 staff to upload and notify stipulation, or certain portions of it, to appropriate members for review based on entities impacted. The system provides the capability to configure and execute certifications based on predefined 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.

Downloads

• Datasheet: Regulatory Examination Management
• Case Study: A Leading Health Insurance Provider Strengthens Compliance Management

Featured

Recorded Webinar: Streamlining Regulatory Exams: Building Trust & Credibility with Regulators
Expert Speaker: Jo Ann S. Barefoot
Co-Chair, Treliant Risk Advisors

Analyst Research

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