Your audit prep takes 200+ hours because documentation is scattered across email, spreadsheets, and filing cabinets
Regulators demand complete audit trails. Your team scrambles to reconstruct claim histories from emails, notes, and undocumented phone calls. Regure makes every claim audit-ready from day one.
Fragmented systems create compliance risk and audit nightmares
The Audit Scramble
When regulators request claim files for audit, claims teams face weeks of document reconstruction:
- Email archeology: Searching through thousands of emails to find correspondence related to specific claims. Attachments saved locally on departed employees' machines are lost forever.
- Incomplete documentation: Phone calls and in-person conversations undocumented. No record of why decisions were made or who made them.
- Missing timestamps: Can't prove when documents were received, when actions were taken, or when notifications were sent.
- Version chaos: Multiple versions of estimates, medical records, and settlement calculations exist with no clear record of which is authoritative.
- Manual assembly: Claims staff manually compile PDFs, spreadsheets, and email threads into "complete" claim files — taking 3-5 hours per claim.
- Compliance gaps: Discover during audit prep that required documents are missing, statutory notices weren't sent, or reserve adjustments lacked approval documentation.
For a typical audit of 50 claims, preparation requires 200-300 hours of staff time. Every audit finds deficiencies.
The Regulatory Risk
Incomplete documentation creates serious regulatory and legal exposure:
- Market conduct violations: Failure to document claims handling decisions leads to regulatory findings and fines. State insurance departments can impose penalties of $10K-$50K per violation.
- Bad faith litigation: Incomplete documentation leaves carriers unable to defend claims handling decisions in bad faith lawsuits. Juries award punitive damages when companies can't prove reasonable investigation.
- Privacy breaches: Unsecured emails and local file storage violate HIPAA, GLBA, and state privacy laws. Data breach notification costs average $200K+ per incident.
- Reservation of rights failures: Can't prove timely notice to insureds about coverage questions. Carriers lose coverage defenses due to documentation failures.
- Unfair claims practices: Pattern and practice violations discovered during audits result in consent orders, operational restrictions, and reputational damage.
Claims operations evolved around speed and workflow — not documentation and audit trails
Fragmented Systems
Claims teams use 5-10 different systems daily: email, claims platform, document storage, spreadsheets, communication tools, payment systems. Each system maintains its own records with no central audit trail.
When it's time for audit, staff manually reconstruct timelines from fragments scattered across disconnected platforms. Critical documentation inevitably gets missed.
Email-Based Workflows
Email is where most claims work actually happens — but email creates no audit trail. Messages are scattered across individual inboxes. Deleted emails are gone forever. No record of read receipts or delivery confirmation.
Regulators don't accept "I sent an email" as documentation. They need proof of delivery, content, and recipient acknowledgment.
Undocumented Decisions
Claims adjusters make dozens of judgment calls daily: is this coverage valid? Is the estimate reasonable? Should we settle or deny? These decisions often happen in phone calls or hallway conversations with no documentation.
When auditors ask "why did you settle for this amount?" the only answer is "the adjuster thought it was reasonable." That's not acceptable documentation.
No Immutable Records
Documents stored in network folders or email can be edited, deleted, or backdated. There's no proof that records haven't been tampered with post-facto.
Regulators and courts require immutable audit trails showing exactly when records were created and by whom. File systems and email don't provide this.
Immutable audit trails and complete documentation for every claim, automatically
Regure is built for compliance-first claims operations. Every document, action, decision, and communication is logged in an immutable audit trail with timestamps, attribution, and full version history. Claims are audit-ready from day one.
1. Complete Centralized Records
Every piece of claim-related information lives in one system with full audit trail:
- Documents: All documents centrally stored with metadata (received date, source, sender, document type). Automatic deduplication prevents duplicate storage.
- Communications: Email correspondence, SMS messages, portal messages, and phone call logs all captured and attached to claim files.
- Actions and decisions: Every workflow action logged: claim assignments, status changes, approvals, denials, reserve adjustments, payment authorizations.
- Data changes: Full version history of data fields. See what changed, when, by whom, and why.
- System events: Automatic logging of document receipt, classification results, routing decisions, notification delivery.
Nothing is scattered across email or local files. Everything is centralized, indexed, and searchable.
2. Immutable Audit Trail
All records are stored in append-only audit logs with cryptographic integrity verification:
- Records cannot be edited or deleted after creation
- Timestamps are tamper-proof and synchronized to authoritative time sources
- Cryptographic hashing proves records haven't been altered
- User attribution for every action (cannot be spoofed or backdated)
- Complete chain of custody for documents from receipt through settlement
Regulators and courts can trust that records reflect actual claim history, not post-facto reconstruction.
3. Automated Compliance Checks
Regure continuously monitors claims for compliance with statutory requirements and internal policies:
- Statutory deadlines: Auto-tracking of acknowledgment letters, coverage decisions, payment deadlines by state. Alerts when deadlines approach.
- Required documentation: Flags claims missing required documents (police reports, medical records, signed releases, proof of loss forms).
- Authority limits: Prevents unauthorized settlements or payments exceeding adjuster authority levels.
- Reservation of rights: Tracks coverage questions and ensures timely reservation letters are sent and documented.
- Claims handling standards: Monitors compliance with internal handling guidelines (contact frequency, documentation standards, investigation requirements).
Compliance issues are caught in real-time, not discovered during audits.
4. One-Click Audit Packages
When auditors request claim files, Regure generates complete audit packages instantly:
- Select claims by date range, claim type, adjuster, or office
- System compiles complete claim files including all documents, correspondence, actions, approvals
- Generates audit report showing compliance with statutory requirements
- Exports to PDF with table of contents, index, and timeline
- Digital delivery via secure portal (no USB drives or file sharing)
What used to take 200+ hours of manual compilation now takes 10 minutes. See Document Processing for details on centralized storage.
5. Compliance Reporting
Regure provides built-in compliance reports for internal monitoring and regulatory filings:
- Statutory compliance: Claims meeting vs. missing statutory deadlines by state and claim type
- Cycle time reporting: Average days from FNOL to acknowledgment, coverage decision, settlement offer, payment
- Exception reporting: Claims missing required documentation, exceeding authority limits, or flagged for unusual activity
- Pattern analysis: Identify potential unfair claims practices (systemic delays, low-ball settlements, improper denials)
- Market conduct prep: Pre-built reports matching common regulatory exam requests
Operations leaders can identify and correct compliance issues before they become audit findings.
6. Security and Privacy Controls
Regure meets regulatory requirements for data security and privacy:
- Enterprise-grade security: Independently verified security controls and processes
- HIPAA compliant: BAA available for protected health information. Encrypted storage and transmission. Access controls and audit logs.
- State privacy laws: Compliant with CCPA, NYSDFS Cybersecurity, and state insurance data security laws
- Role-based access: Granular permissions ensuring users only see claims and data they're authorized to access
- Multi-factor authentication: Required for all user access
- Encryption: AES-256 encryption at rest, TLS 1.3 in transit
Security and privacy are built in, not bolted on. Reduces risk of data breach notifications and regulatory penalties.
95%+ reduction in audit prep time. Zero documentation gaps. Complete regulatory confidence.
Complete claim files generated in minutes instead of 200+ hours of manual compilation. Staff redirected to productive work.
Every claim has complete audit trail from FNOL through settlement. No missing documents. No gaps in timeline.
Automated tracking and alerts ensure acknowledgment letters, coverage decisions, and payments meet state requirements.
Real-time compliance monitoring catches issues before audits. Compliance exception reports enable proactive correction.
Regulators request 50 claim files for review. Complete audit package generated and delivered in 10 minutes.
Independent verification of security controls and HIPAA compliance. Reduces regulatory risk and customer concerns.
Real-World Example: Workers Comp TPA
A workers comp TPA managing 12,000 active claims faced a state department of insurance market conduct examination. They had 30 days to produce complete files for 75 randomly selected claims. Past audits required 250+ hours of staff time and resulted in multiple findings for incomplete documentation.
After implementing Regure 8 months prior:
- Generated complete audit packages for all 75 claims in 12 minutes
- 100% of claims included complete document sets, communication history, and action logs
- Automatic compliance report showed 100% statutory deadline compliance (vs. 87% in previous audit)
- Examiners noted "exceptional documentation quality and completeness"
- Zero findings related to documentation or recordkeeping (vs. 14 findings in previous audit)
- Staff time saved: 245 hours redirected from audit prep to claims handling
"Previous audits were nightmares. Staff working weekends to reconstruct claim files. We'd still end up with missing documentation and regulatory findings. With Regure, the audit was almost pleasant. Complete files at the click of a button. Zero findings. The examiners were impressed." — VP of Claims Operations
Compliance starts with complete documentation and centralized systems
Document Processing Platform
Learn how Regure centralizes all claim documents with automatic metadata, version control, and immutable storage.
Claims Automation Platform
See how workflow automation ensures every action is logged, approved, and documented according to compliance requirements.
Email-to-Claim Automation
Stop losing documents in email. Automatic email processing ensures every document is captured, classified, and centrally stored with audit trail.
Security & Compliance
Deep dive into Regure's HIPAA compliance, enterprise security, encryption, access controls, and security architecture.
See how Regure solves this for your team
Book a 20-minute demo and we'll show you complete audit trails, compliance reporting, and one-click audit package generation. Bring your toughest compliance challenges.