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Why Employers Audit Their Benefit Plans
Why Employers Audit Their Benefit Plans
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TFG Partner, LLC
1 post
Sep 08, 2026
10:37 PM
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ompanies that self-fund their medical and Rx plans are required to conduct periodic audits. However, beyond regulatory obligations, setting up claim administration initially is vital, including accessing PBM RFP consulting Top audit firms now review 100% of claims, an advancement over random sampling methods. If you are responsible for managing your company’s benefit plan, maintaining oversight of claims administration is vital—and only a comprehensive audit delivers the insight you need. Complete audits give you the necessary data to operate a more efficient and financially sound self-funded plan.
Common claims processing errors frequently uncovered by audits include filling prescriptions with costly name-brand drugs when generics are available. This practice provides no added value to health plan members but substantially increases prescription costs. A thorough claims audit identifies such issues, allowing you to stop wasteful spending and save thousands of dollars. Over time, these savings can add up significantly, especially for larger organizations with self-funded plans, resulting in substantial financial benefits. Well- managed plans also serve their member better and more consistently.
If you are responsible for managing a company health plan, eliminating errors and saving money while ensuring excellent service will earn you recognition. Claims administrators perform more diligently when they know their work is being thoroughly reviewed using factual data. Only a 100% audit delivers the accuracy needed for effective plan management. When reporting to upper management or finance professionals, having concrete data from comprehensive audits greatly strengthens your position and credibility. It also strengthens your hand in negotiations with administrators over work accuracy.
To further enhance your plan, consider ongoing monitoring, a service where an audit firm reviews your claims in real-time. This approach allows errors to be caught and addressed immediately, preventing minor issues from growing into major problems. The cost for continuous monitoring is often offset—or even surpassed—by the value of the errors detected and corrected, making it a budget-neutral or positive investment. Benefits managers who review continuous monitoring reports are often impressed by the level of detail and actionable insights provided, leading to more effective plan management.
Last Edited by TFG Partner, LLC on Sep 08, 2026 10:41 PM
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