Business Details
36 Years
experience
Trusted Insurance Audit Services in Daytona Beach
Established in 1990, we provide specialized insurance audit services rooted in decades of industry expertise. Our team combines deep knowledge of health insurance and claims administration to deliver precise, reliable audits that enhance operational integrity. We pioneered a methodology where independent audits significantly improve claims accuracy by addressing errors proactively. Our nationwide reach enables collaboration with insurance companies and third-party administrators through both remote and in-person engagements. Clients receive comprehensive reporting tailored to their needs, including real-time updates and detailed statistical summaries. With over 30 years of experience, we maintain a commitment to transparency and quality, ensuring clients achieve optimal outcomes in claims management.Our unique value lies in our ability to audit both financial aspects and plan benefit accuracy, a capability honed through partnerships with major industry players. We have supported critical projects such as state insurance department transitions and PPO comparisons, demonstrating our adaptability to complex challenges. Our services extend beyond audits to include training, system implementation support, and operational consultations that drive long-term improvements. By maintaining rigorous standards and leveraging our extensive experience, we position ourselves as a trusted partner in the insurance industry.
Services
Internal Audits
External Audits
PPO Comparison
Claims Audits
System Implementation Audits
Disability Audits
Performance Guarantee Audits
New Examiner Audits
High Dollar Payment Audits
Details
- Year established: 1990
Highlights and features
- We offer 30+ years of specialized insurance audit expertise
- Our nationwide availability supports remote and in-person engagements
- 100% transparency in audit processes and reporting
- Proven track record with state insurance departments and major TPAs
- Customized audit solutions for complex insurance scenarios
Services
Internal Audits
We conduct comprehensive internal audits for third-party administrators, examining both manual and automated claims processing. Our process verifies system programming accuracy and examiner performance while providing TPA clients with independent quality assurance. With daily error tracking and performance improvement suggestions, our audits have demonstrably improved external audit outcomes for clients through proactive error correction.
External Audits
Our external audit process evaluates claims processing integrity through on-site reviews and statistical sampling. We analyze 250 random claims to assess adherence to plan provisions, including system functionality reviews and workflow observations. Clients receive detailed reports with statistical summaries and actionable recommendations to enhance claims management practices while ensuring compliance with industry standards.
PPO Comparison
We provide comparative analyses of preferred provider organizations for self-funded employers. By evaluating local provider discounts and service qualifications in TPA/insurance company proposals, we help clients make informed decisions about network selection. This service ensures optimal cost savings while maintaining quality healthcare delivery for employee benefit programs.
System Implementation Audits
We audit claims systems during implementation phases to verify correct programming of plan documents. Our team ensures system capabilities align with required adjudication functions while training personnel on quality control procedures. This proactive approach prevents systemic errors and establishes efficient claims processing workflows from initial system deployment.
Disability Audits
We conduct specialized audits focusing on disability claims processing accuracy. Our examiners verify benefit calculations, eligibility determinations, and compliance with specific plan provisions. These audits help identify systemic issues in disability claims management while providing actionable recommendations to improve payment accuracy and regulatory compliance.
People
Mary Jean Mullally
President/CEO
With over 30 years of insurance industry experience, Mary Jean Mullally founded Mullally Insurance Services in 1990. As former auditor, trainer, and claims examiner for major TPAs, she brings deep expertise in claims accuracy and benefit plan analysis to lead our audit operations.
Questions
What types of insurance audits do you specialize in?
We specialize in internal and external medical claims audits, PPO comparisons, disability audits, and system implementation audits for third-party administrators and insurance companies.
How do your audits improve claims accuracy?
Our audits identify errors in real-time through daily reviews and provide actionable recommendations to improve examiner performance and system programming accuracy.
Do you work with clients outside Florida?
Yes, we provide nationwide audit services with remote and on-site capabilities across the United States.
What reporting options are available?
Clients receive customizable reports by examiner, group, or supervisor through our database system, with real-time updates and detailed statistical summaries.
How do you handle new system implementations?
We audit system programming against plan documents during implementation and train personnel on quality control procedures to ensure accurate claims processing from deployment.
Can you assist with PPO network selection?
Yes, our PPO comparison service analyzes local provider discounts and qualifications to help self-funded employers make informed network decisions.
