Manage and Administer Benefits: Health Insurance Broker/Agent RCM

A successful risk management strategy requires a strong internal control environment. The RCM format emphasizes that strong and risk-oriented internal control environments are often optimized with automated/manual controls, depending on the situation.

An RCM provides an overview of different control objectives that organizations should take into consideration and the corresponding controls to safeguard the company against risks, which may arise if not checked timely. Once customized to an organization, this document can help the user in assessing each control. The control assessment can then also be summarized to develop an action plan.

This document outlines risks and controls common to the health insurance broker/agent aspect of the 3.5.7 Manage & Administer Benefits process in a risk control matrix (RCM) format.

Sample risks include:

• The broker’s selection of insurers/agent’s selection of insurance plans does not fit the needs of the company.
• The company provides restricted information within its workforce report to the broker/agent.
• The insurer files for bankruptcy and/or the insurer’s group health plan and customer service is of low-quality.
• The quote for insurance coverage changes before the company signs the contract with the insurer.
• The range of needed coverage, as determined by the board of directors/benefits committee, is not valued by the organization’s employees.

This document can be used as a sample RCM and is not meant to be an exhaustive list of risks and controls. The KnowledgeLeader team will periodically update this RCM with new content. Organizations should select, update and modify the risks and controls included in this document to ensure that it reflects business operations.