Appeals and Grievances Audit Work Program

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Examining Appeals and Grievances Workflows To Identify Process Gaps

Organizations can use the best-practice general steps included in this document to conduct an appeals and grievances audit. 

Sample audit steps include:

  • Identify key stakeholders and decision-makers
  • Confirm and communicate the straw man operating model and key actions
  • Define structures and roles of appeals and grievances for transformation
  • Confirm drivers of change and perform a diagnostic review of the current state
  • Review existing documentation/data gathering of the current process (e.g., workflows and policy and procedure documents)
  • Conduct walk-throughs for people, processes and technology
  • Assemble the transformation road maps
  • Determine if a steering committee should be established