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Name: Sundar Victor, Sr. Manager Data Science & Rahul Sharma, Data Analytics Manager
Overview of Use Case
Learn how Aetna used the Alteryx platform to launch robotic automation tools for their internal audit department. The company changed the face of their internal audit practice, saving millions of dollars in potential claims overpayments, strengthening their internal control environment to mitigate existing and emerging key risks, and saving their audit team five to eight days per audit
Describe the business challenge or problem you needed to solve
The Analytics journey at Aetna began with a vision from leadership to incorporate data within the traditional process to remove inefficiencies and reduce the amount of time and effort required to conduct an audit. Internal audit processes are time consuming, tedious and very labor intensive.
The Pain Associated with the Traditional Audit Process
In a typical company, the audit process starts with risk monitoring activities on the macro level and then drilling in to understand how these risks are affecting processes within the company.
The first pain point in any audit is making the auditors understand your processes, as they are not subject matter experts in your business. They are risk and control experts. It is essential is to equip auditors with data, so they can assess which risks which are inherent to your business process.
Another step in the traditional audit process is control assessment, where they test a sample of the population. This is where Aetna leadership had concerns, as they questioned if Aetna was testing a truly representative sample of the population.
The traditional audit process is manual takes from two to six months, depending on how complex the process. It needed to be automated to drive efficiencies.
Describe your working solution
Aetna has established a data analytics integrated audit processes. This includes, but is not limited to:
Continuous Audit Models
The Data Science team uses Alteryx to build out risk models. These models produce a list of the riskiest transactions. Instead of testing a sample of the population, Alteryx has allowed Aetna to test all 10 million transactions to ensure they address all risk.
Audit Plan Visualization
The team used Alteryx to create an application that reports on audit plans. Leadership wanted insight into where audits were occurring and how resources were being structured.
Audit Plan Status Report
The Data Analytics team used Alteryx to create an application for their semi-annual audit plan. This audit plan typically shows the number of audits in process, what area of the business they are in and assess high or low-risk. The report is readily available to the internal audit management and executive leadership teams.
Automated Audit Reports
Alteryx allows the leadership team to look at variables associated with each audit at any point in time. For example:
- How many issues were there?
- What is the completion date of that?
- What is the management action plan?
- What is the status of the completion of that issue?
The leadership team is using Alteryx to determine which resources are the best fit based on expertise and availability.
- The entire population is tested rather than sample testing, allowing for higher assurance on accuracy and completeness.
- When reviewing claim payments using a sample of the population you may miss a trending issue. However, when testing an entire population, you will be able to zero in on the problems and address them, such as overpayment on specific claim types.
Each quarter, the Data Science team performs six to eight audits. Before Alteryx, the team would spend five to ten days building a dashboard for auditors to better understand their data. Today, the Data Analytics team uses Alteryx to provide process insight to auditors before the actual claims process begins.
- Aetna established a self-service analytics server with Alteryx that is called ELI Robot. The ELI Robot has removed the need for the data science team to create dashboards for auditors. Auditors can now use the self-service dashboard for any information on the current audit. Everything is entirely automated, and the data science team no longer needs to be involved in the process. The dashboards are built in under five minutes and the user receives the information via email in near real-time.
- Alteryx has been able to save the Data Science team roughly 20-30 full-time employee hours per project.
Describe the benefits you have achieved
In summary, Aetna has experienced several benefits by incorporating data into the audit process. Including, but not limited to:
- Gaining high assurance accuracy and completeness through transactional testing of the entire claim population
- Providing visibility into the data process for auditors to gain insight before the claims process begins
- Self-service audit dashboards that are automatically generated without the involvement of the data science team
Aetna is now performing continuous auditing by automating end-to-end process review instead of the manual six-month process. Previously, when Aetna would go through an audit, they typically would not revisit the business process until nearly three years later.
Any issues with the process would go undetected during that entire time. Using the continuous audit model with Alteryx, the team can monitor transactions monthly and address issues immediately, diving a higher confidence in their process and significant cost savings in paying incorrect claims.
The entire PowerPoint presentation can be found attached below. Additionally, visit thislinkto watch the entire recorded session.