ACL Success Story – Insurance – BlueCross BlueShield of South Carolina

2010-11-01

BlueCross BlueShield of South Carolina

“ACL is a technology solution, but it has a profound behavioral impact on our organization. The interactive nature of the client/server architecture allows you to interrogate the data, make critical decisions on which areas to drill down into, and then refine your audit plans based on the complete picture. ACL allows us to constantly make substantive improvements to procedures that mitigate business risks and improve our bottom-line performance.”

Brian W. Harris, Corporate Audit Division, BlueCross BlueShield of South Carolina

BlueCross BlueShield of South Carolina is the state’s largest health benefits organisation, serving over 21 million customers nationwide each year. To meet the needs of group health policy holders, BlueCross required a more effective and efficient means of accessing data files directly from the company’s enterprise server. After experiencing considerable success with ACL Analytics Edition throughout the company, the BlueCross audit team implemented the ACL Server Edition for z/OS. This software enables BlueCross to read and analyse data residing on their enterprise server, without the need to go through the added steps of defining what, where, and how data is stored. The ability to directly access enterprise server data – while complying with existing security protocols – helps maintain the independence of the data analysis process, frees the audit department from IT scheduling constraints, and improves overall audit efficiencies and productivity.

Company Overview

Established in 1946, BlueCross BlueShield of South Carolina is a mutual insurance company owned by its fully insured members. Headquartered in Columbia, SC, BlueCross has over 13,000 employees and offices located throughout the state and nation. In the early 1980s, BlueCross introduced an innovative and comprehensive managed care program, and today, one in three South Carolinians are covered by BlueCross’ market-leading benefits plans. The company is a major government contractor for Medicare and military claims administration, and offers complementary products and services through its many subsidiaries.

Applications

BlueCross uses the ACL Server Edition for z/OS in conjunction with ACL Analytics software to gain seamless access to enterprise server data without the need for complex and time-consuming data extractions.

Challenges

Rising benefit costs pose a considerable challenge for health insurance companies such as BlueCross – a challenge that’s compounded as employers try to contain and manage internal expenses. Increasingly, client groups and large employers are requesting extensive data files to support their own audits as they look for greater cost efficiencies and tighter compliance with corporate claim policies. Faced with numerous and diverse data requests, the BlueCross audit team was searching for a more efficient way to supply this audit information and to help both the company and its member-employers manage their business risks.

In one year alone, BlueCross has processed more than 295 million claims and six billion transactions. With daily data volumes measured in terabytes, BlueCross required a powerful and flexible technology solution to boost audit efficiencies and maximise staff time and resources. Most significantly, the internal audit department needed a way to directly access the vast volumes of policy data housed on its enterprise server.

Finally, BlueCross auditors often receive urgent data requests and work under tight reporting deadlines. Auditors need to quickly access and analyse large data files, for both internal senior management and for the audit departments of member organisations and companies.

Solutions

Thanks to the vision and support provided by the BlueCross management team, the internal audit department implemented ACL Server Edition for z/OS and continues to expand its use throughout the organisation.

By adding the ACL Server Edition for z/OS software to its existing ACL Analytics use, the BlueCross internal audit team extended its reach into enterprise data and has seen marked improvements in productivity and efficiency. Working within the same client user interface – eliminating any need for retraining – the audit team now can move seamlessly to access and analyse transactional data residing on the enterprise server, without time-consuming extractions or added security risks. The client/server architecture eliminates the need to extract, download, duplicate, or convert data.

With full data coverage, the BlueCross audit department also can respond more quickly to time-sensitive reporting deadlines and other information requests. With ACL, auditors can act independently and obtain their data in a matter of hours. “Having complete and unobstructed access allows us to react quickly to the deadlines and to identify opportunities to enhance both operational and IT controls,” says Brian W. Harris, Corporate Audit Division, BlueCross BlueShield of South Carolina.

ACL technology has helped the audit department implement best practices that allow the company to maximise business assurance, controls compliance, and fraud detection efforts. BlueCross’ corporate governance structure mirrors that of a public corporation. To increase stakeholder value, BlueCross auditors require technology designed to support effective identification of risks and comprehensive testing of internal controls. With ACL, BlueCross has powerful software solutions to help isolate risk indicators, that in turn are used to develop business strategies that address controls compliance issues.

Due to the high visibility and productivity improvements ACL has enabled within the internal audit department, BlueCross continues to expand its use of ACL software into accounts payable, litigation support, data quality assurance, accounting, investigations, and other areas of the organisation.

Results

BlueCross BlueShield of South Carolina has leveraged the power of ACL Server Edition for z/OS to:

  • Gain full data coverage and attain independent transactional analysis capabilities, free from IS scheduling constraints
  • Identify internal controls weaknesses and develop strategies to enhance business assurance practices
  • Identify overpayments and duplicate payments
  • Mitigate time pressures and respond to data analysis requests with greater ease and efficiency
Monday, November 1, 2010 In: Client Success Stories, Hot Topics Comments (None)

Contact

Pricing

Demo