SERVICE 05

Quality Assurance & Exception Handling

Independent second-level checking to identify processing errors, missing information and records that require client review.

Service Overview

Structured support for repetitive insurance operations

Our QA workflow adds a separate review stage after processing. Instead of treating every record as complete, records are checked against agreed rules and exceptions are clearly separated for review.

What We Handle

  • ✓Processed insurance records
  • ✓Missing-field checks
  • ✓Document checks
  • ✓Name mismatches
  • ✓Amount discrepancies
  • ✓Duplicate concerns
  • ✓Formatting issues
  • ✓Records requiring client clarification

Our Processing Approach

What we actually do

The exact workflow is agreed with the client before processing begins. A typical process looks like this:

1

Receive the processed batch.

2

Review the agreed QA checklist.

3

Sample or review records according to the agreed scope.

4

Compare source information with processed output.

5

Identify errors and exceptions.

6

Classify exceptions by type.

7

Prepare the QA summary.

8

Return corrected records or review-required records.

Workflow

From source files to final delivery

STEP 1
Processed Batch
STEP 2
QA Checklist
STEP 3
Source Comparison
STEP 4
Exception Identification
STEP 5
Correction / Review
STEP 6
QA Report
SYNTHETIC EXAMPLE

Synthetic QA Review Example

This is an illustrative demonstration workflow using synthetic information. It is not a real client engagement.

1. Client Input

  • •Batch size: 100 claim records
  • •Processed output: Excel file
  • •Source documents available for comparison

2. Our Processing

  • •QA reviewer compares processed records against source information.
  • •Required fields are checked.
  • •Amounts, names and document status are reviewed.
  • •Exceptions are categorized.

3. QA / Exceptions

  • •Record 024: Missing document
  • •Record 037: Name mismatch
  • •Record 061: Amount discrepancy
  • •Record 089: Possible duplicate

4. Final Output

  • •QA-reviewed batch
  • •Exception report
  • •Exception categories
  • •Records requiring client decision
  • •QA summary

What the Client Receives

Typical deliverables can include:

  • ✓QA-reviewed dataset
  • ✓Exception report
  • ✓Exception categories
  • ✓Correction list
  • ✓QA summary

Quality Checks

Depending on the agreed scope, checks may include:

  • ✓Source-to-output comparison
  • ✓Required-field checks
  • ✓Document verification
  • ✓Amount comparison
  • ✓Duplicate review
  • ✓Exception categorization

Who We Support

Designed for defined insurance workflows

We can support organizations that need structured back-office processing, validation, QA or reporting support.

✓Claims operations teams
✓Insurance agencies
✓Brokers
✓TPAs
✓Outsourced processing teams

Start With a Controlled Pilot

Test the workflow before moving to recurring support.

Share your process, approximate monthly volume, file format and required turnaround. We can review the workflow and define a practical pilot scope.

Request a Pilot →