Interactive Auditor Dashboard (Insurance) Basma Moharram AIS - PhD Candidate Rutgers University

Transcription

1 Interactive Auditor Dashboard (Insurance) Basma Moharram AIS - PhD Candidate Rutgers University

2 The Data Type of claims we have: Life / Disability. Group / Individual. For these claims we have information about: Coverage Beneficiaries Collection of Premiums Payments of Claims 2

3 The Objectives For our work with ITAU Insurance we have different objectives. For the purpose of this presentation we are only discussing the following objectives: Creating an Auditor Dashboard to assist in the audit plan. We are using guidelines from the AICPA electronic guide book for Life and Accidental Insurance. 3

4 Auditor Dashboard We start with the business cycle. We then breaks it down into the main functions within this business cycle. For each main function we think of the possible assertions the auditor would want to test. We design an interactive visualization to help the auditor with these assertions. The following is an example form the Claim Payment Cycle.

5 Life / Disability Insurance Benefit and Claim Payments Cycle Receiving Claims Explorat ory Analysis Accept/Re ject Claims Determi ning Claim Payment Authori zing Payment Payment Maintai ning Contract s Understan ding Claims Hierarchy. Claim Anomalies Reasoncoverage associati on. Group Similariti es Calculations of appropriate claim payment is done in accordance with legal contract Checking Authorizatio n limits Reviewing Approvers activities. All claims paid or incurred represents valid obligations under the contract in force.. Claim settlement is reasonable Contracts status are properly updated after approving the payment. Contract liability are properly updated after approving the payment. In Progress Done Yet to be Started

6 EXPLORATORY ANALYSIS 6

7 Exploratory Analysis Beginning Effective Date Distribution A Chart showing the distribution of the Beginning Effective Date of policies (D_INI_VIG) From the chart an auditor will see that there are high activity between May first and July first You can filter by year. You can see actual data records by right clicking on any node.

8 Exploratory analysis Claim Values The top Chart shows the amount of Claim payments made to clients by company code (COD_CIA) The lower chart shows the same graph only now we have filtered for a specific range of payments Using this graph, an auditor will gain an understanding of the claim payments made by different companies. 8

9 Exploratory analysis Claim Values Same chart as previous slide but now we can see a drill down from Company level, down to activity per each company (COD_RAM O), to product per each activity per each company, until we go down to each single claim. 9

10 Example of AUDIT ASSERTIONS 10

11 Had the approvers exceeded their Authorization Limits? A Chart Comparing the Authorizatio n Limit of the approver (Green) with the actual payments he approved (Orange). You can filter by approver or by Payment month of year. You can see actual data records by right clicking on the specific column you want to see its data.

12 A chart showing both the number of transactions authorized by a specific approver (The higher the number of claims, the bigger the size of square) and the total monetary value he authorized as claim payments (the higher the value, the darker the green) Approvers Activity You can filter by claim monetary value and/or approver s name. An auditor using this graph might be interested in the approver who approved the highest monetary value, or he might be interested in the approver who only authorized one single transaction (smallest square on the lower right corner). 12

13 Approvers Activity: Detailed The top chart shows the approvers total claim payments for each year (2011, 2012) The bottom Chart shows the claim Hierarchy (COD_CIA, COD_RAMO, COD_PRODUTO, NUM_APOL, And NR_SINSTRO) When an auditor select a specific approver s activity from the top chart, the bottom chart will automatically shows only the claims approved by this approver. You can filter for approvers, year of payments, and/or value paid.

14 A Chart showing the payment percentage (amount paid / face value) From the chart an auditor will easily see which claim needs to be investigate d further IS the claim settlement reasonable? VIEW 1: Interest Rates You can see actual data records by right clicking on the specific circle you want to see more 14

15 A Chart showing the Relationship between Interest Rates and Days till Payment. IS the claim settlement reasonable? VIEW 2 Interest Rates with Days till Payment From the chart an auditor will easily see where the relationship does not make sense (higher rate with fewer days till payments. You can filter by number of days or by interest percentage You can see actual data records by right clicking on the specific node you want to see more details about. The example shown in the chart means that the company paid 14100% in excess of face value per day over 30 days. 15

16 A Chart showing the Relationship between Interest Rates (higher as size of circle gets bigger) Different Approvers. IS the claim settlement reasonable? VIEW 3 Interest Rates with Approvers From the chart an auditor will easily see the approvers with unreasonable interest rates. You can filter by approvers You can see actual data records by right clicking on the specific approver (Circle) you want to see 16

17 Audit Assertions IS the claim settlement reasonable? Interest Rates 17

18 Audit Assertions IS the claim settlement reasonable? Interest Rates with Days till Payment 18

19 Audit Assertions IS the claim settlement reasonable? Interest Rates with Approvers 19

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