Which of the Following Procedures Would Be Most Effective in Detecting

question 114

Multiple Choice

Which of the following procedures would be most effective in detecting fraud in electronically-submitted claims to insurance companies?

• A) Creating a monitoring program that detects unusual claims to be investigated by the claims department.
• B) Using generalized audit software to match the claimant identification number with a master list of valid policyholders.
• C) Testing the accuracy of processing by using integrated test facilities.
• D) Creating batch controls over all claims arriving from a particular organization and process those claims separately.

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Definitions:

Corporate Policy

Guidelines and rules established by a business or corporation to govern its operations, employee conduct, and ethical standards.

Paid Labor Force

Individuals who are employed and receive compensation for their work or services.

Economic Sociology

A branch of sociology that examines economic phenomena including markets, exchange, and capital systems.

Market Structure

The organizational and other characteristics of a market, determining the nature of competition and pricing strategies within it.