Insurance - Solution Capabilities

With over 100,000 active users, the Compliance 360 on-demand solution is one of the most widely used and comprehensive Governance, Risk and Compliance (GRC) solution in the insurance industries. Key capabilities of Compliance 360 for insurance include:

With Policy and Procedure Management, insurance companies can ensure full life-cycle management of policies and procedures including, automatic email reminders, easy keyword searching and customized workflow for collaboration and approval activities.  Other key features of the policy management system include the ability to monitor activities through version control, full audit trail capabilities as well as surveys of your employees to ensure they have read and understand each policy.  With Policy and Procedure Management, policies and procedures are organized with respect to the regulations that impact your business enabling you to provide real-time evidence of compliance. View Demonstration

With 1,000’s of regulations, varying from state to state, it is very difficult to manage all the regulations that apply to each local insurance entity or plan. Most insurance organizations struggle to keep up with changing regulations and ensure that the appropriate personnel are notified of subsequent changes to standard operating procedures. Compliance 360 offers integrated access to the broadest available selection of legal and regulatory content available in the industry today.  This is accomplished through our direct links to two of the world’s leading legal and regulatory content databases, LexisNexis and the Westlaw database from Thomson Reuters.

At the heart of the Compliance 360 solution, the Regulatory & Content Repository is used to gather actionable laws and regulations into a central content repository and provide automated alerts for any changes and disseminate the appropriate information to targeted individuals throughout your organization.

Legal and regulatory content is the fuel that drives the governance, risk management and compliance (GRC) application engine for most regulated organizations.  In turn, the GRC application greatly reduces manual overhead and makes the legal and regulatory content actionable.  The integrated combination of relevant content and the Compliance 360 application creates a highly valued business solution for insurance companies across the United States. 

The Incident Management module helps insurance companies manage a wide variety of issues such as fraud hotline tips, potential fraud and abuse occurrences, audit findings and legal cases. The Incident Module collects, stores, and allows your departmental personnel to collaborate on compliance-related incident information and track the progress of investigations.  All incident information can be included in reports and graphically represented to demonstrate trends and correlations.  Compliance managers will frequently use this area for audit committee meetings and board meeting presentations, as well as external audits, market conduct examinations, and required disclosures related to corporate integrity agreements.

The Virtual Evidence Room™ provides a collection point where all your compliance activities are easily tracked and linked back to the related laws, regulations or standards. The unique Virtual Evidence Room facilitates any type of audit, investigation or survey such as a Market Conduct Examination, OIG investigation, state audit or accreditation.  Armed with this unique capability, you can easily demonstrate proof of compliance for any type of audit, lawsuit or investigation.  The Virtual Evidence Room ensures that you are always audit-ready with one verifiable version of the truth.

With 1,000’s of regulations, varying from state to state, impacting the typical insurance company, you need the ability to determine key risk areas across your various plans. Routine Self Assessments demonstrate proactive measures established to ensure compliance and thus reduce the likelihood of a failed audit or market conduct examination.  With Compliance 360, insurance companies can automatically monitor compliance status using a complete suite of assessment tools that include the ability to distribute risk assessment surveys to targeted employees via email.

With complex legal requirements related to 3rd-party vendor compliance, agent agreements and HIPAA Business Associate agreements, keeping track of all your contractual obligations is essential to any insurance organization.  With Contract Management, health plan providers can create, manage and organize contracts for improved access, collaboration, revisions and approvals, and version control. The system provides automatic e-mail alerts when contracts require review.  This is often used in conjunction with the Survey Module to ensure compliance throughout the virtual organization of business partners.

Effective project management within an insurance organization most often requires centralized coordination of multiple resources across a variety of departments, disciplines and objectives.  With Compliance 360, insurance companies can create and manage unlimited project types such as for market conduct examinations, corporate integrity agreements, investigations, remediation and audit response.  The solution enables enterprise-wide project management using automated task management to promote collaboration and accountability, and provides extensive review and reporting capabilities.

Because of mandates concerning conflict of interest, employee satisfaction and general requirements for rooting out fraud and abuse, compliance officers and managers carry the huge burden of collecting and managing vast amounts of data.  The Survey module helps you create and manage customizable surveys for any size population – from a few hundred to thousands of employees, contractors and other appropriate contacts across your entire virtual organization.  With advanced features such as conditional questions, automated workflow and statistical charting, you can address survey / data collection requirements you never thought possible and zero in on otherwise-hidden conflicts of interest.  Additionally, the Survey module can be used to address requirements such as attestations, controls testing and audits.  Survey distribution and summarization can be automated for an unlimited number of respondents.

The Compliance 360 Claims Auditor™ helps insurance companies manage a wide variety of claims audits and appeals.  The Claims Auditor is part of the industry leading Compliance 360 solution that enables a comprehensive approach to regulatory compliance and risk management through one comprehensive, enterprise-wide platform.

The Compliance 360 solution provides real-time graphical reports on a configurable home page with the capability to highlight compliance exceptions across the organization and examine specific compliance breaches and activities in more detail.  Real-time reporting tools provide a global view of all compliance and risk management activities.  Extensive drill-down capabilities and comprehensive search provide quick retrieval of needed information.

Compliance 360’s Risk Management Solution assists organizations with managing the key elements of an enterprise risk management initiative to enable them to achieve their strategic objectives. Compliance 360 automates processes associated with assessing and monitoring risk, managing the risk response strategy, linking risk management data to compliance activities and providing a global view to all risk-related activities through an executive dashboard. Managers are able to quickly assess problem areas, proactively adjust processes to respond to issues and track progress through reports and automated alerts.  The Risk Management solution assists with all the facets of risk management and includes key features such as visual representations of the risk framework, customizable scoring methodology, workflow enabled processing of risk assessments and control tests, and enterprise level visibility and reporting.

As an added benefit that is rapidly growing in importance for many insurance organizations, risk management assessments are now being included in many of the credit and bond ratings conducted by Standard and Poors and other ratings agencies.  The Compliance 360 risk management solution can help insurance organizations proactively demonstrate their risk management initiatives to help preserve and even improve their ratings relative to others in the market.

All publicly traded healthcare organizations are required to comply with the Sarbanes-Oxley (SOX) Act in the U.S. and a growing number of privately held organizations are electing to comply with the “best practices” of Sarbanes-Oxley for a variety of reasons such as maintaining adequate bond ratings.  Complex and cumbersome spreadsheets do not provide the capability to manage the data for governance, risk and compliance initiatives. Compliance 360’s SOX solution is an integrated part of the single, holistic compliance platform. With this solution, you can manage internal controls for financial reporting while integrating all aspects of SOX compliance such as controls monitoring and testing, documentation, risk evaluation and measurement and monitoring with the enterprise governance, risk and compliance strategy.

Most insurance organizations have limited information technology (IT) resources.  These resources are generally dedicated to the core business functions tied to revenue generation, such as claims processing and marketing.  As a result, it is often difficult for non-core business functions to compete successfully for these limited IT resources.  Compliance 360 is designed from the ground up as a SaaS (Software as a Service) solution.  Because of the SaaS design, Compliance 360 is provided as an online service, with no software or hardware to install.  This allows insurance companies to be up and running quickly, often in less than 60 days with little or no overhead created for the IT department.

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To learn how leading insurance companies are using Compliance 360 to minimize their compliance overhead and risks, and how you can be do the same, contact us today.