Highlights
- Automated the collection, review, and submission of audit universes through Inovaare’s Universe Management System (UMS)
- Centralized data management for efficient and accurate universe generation
- Improved compliance monitoring and audit readiness with Timeliness Dashboards
- Significant reductions in audit review time and external audit costs
Quantifiable Results
58%
reduction in time spent on data scrubbing
90%
reduction in audit review time
67%
reduction in the cost of audit follow-ups
90%
reduction in time spent aggregating universe data
The Customer
The client is a Fortune 500 U.S.-based health insurance provider serving millions of members nationwide. With thousands of employees and a broad portfolio of health insurance products, the organization is committed to improving health outcomes through innovation, operational efficiency, and member-first service.
Challenges
The health insurance provider faced significant challenges in its audit and compliance workflows:
- The audit team relied heavily on manual processes, taking more than two weeks to consolidate data from 27+ contributors across the organization.
- Conventional tools like Microsoft Office and SharePoint were used to manage audit files, creating a fragmented, error-prone, and high-stress environment.
- Generating clean, CMS-ready universes was a recurring struggle, often resulting in audit deficiencies and suboptimal outcomes.
- Inefficiencies across the workflow led to elevated external audit costs and time-consuming post-audit follow-ups.
Goals
The existing approach, spread across spreadsheets, email threads, and disconnected systems, was no longer sustainable for a large-scale, high-stakes function like CMS audit readiness. Faced with rising audit complexity, growing data volumes, and the operational strain of manual processes, the health insurance provider sought a smarter, faster way to manage compliance. The key goals it envisioned included:
- Automating the collection, review, correction, and aggregation of audit universes to reduce manual effort, minimize errors, and lower external audit costs.
- Improving audit readiness and data consistency by removing subjectivity in reviews and enabling real-time tracking with built-in Timeliness Dashboards
- Consolidating data from multiple internal sources to support accurate universe generation, ongoing compliance monitoring, and enhanced reporting for better visibility and control across the enterprise
Solution
To modernize its audit and compliance operations, the organization turned to Inovaare’s Universe Management System (UMS), a purpose-built solution designed to automate, standardize, and streamline universe generation and reporting. UMS brought in powerful automation, built-in CMS compliance logic, and scalable data management capabilities to eliminate manual inefficiencies while improving audit accuracy and regulatory confidence.
Key highlights from the deployment include:
- Automated universe processing: UMS streamlined the entire lifecycle, collection, review, correction, and aggregation, of audit universes. The built-in Universe Scrubber scanned up to 100,000 records per minute, drastically cutting down manual review time and minimizing errors.
- Built-in compliance logic: The system came pre-loaded with CMS rules and offered configurable logic for plan-specific validations, reducing the risk of oversight or non-compliance.
- Consolidated data framework: UMS unified data from multiple internal systems to generate clean, audit-ready universe files. This improved reporting accuracy, supported proactive compliance monitoring, and enabled better audit outcomes through data-driven decision-making.
- Real-time compliance insights: The integrated Timeliness Dashboards provided instant visibility into data gaps and outliers, helping the team monitor audit readiness continuously.
Benefits
The implementation of UMS delivered transformative results for the health insurance provider, bringing unmatched efficiency, accuracy, and control to its audit and compliance operations. With UMS, the provider moved from reactive audit management to a proactive, data-driven compliance model.
Key outcomes included:
- Significant reduction in manual effort and errors through end-to-end automation and high-speed universe scrubbing, ensuring audits are prepared faster and with greater accuracy
- Real-time oversight with Timeliness Dashboards that flag data outliers and enable proactive compliance risk management
- Improved data consistency and reliability, achieved by eliminating manual data entry and leveraging built-in CMS compliance logic, resulting in more objective, audit-ready outputs.
Outcomes
The implementation of Inovaare’s Universe Management System (UMS) led to significant, measurable improvements in audit performance, data accuracy, and compliance efficiency for the health insurance provider.
- Audit review time dropped by nearly 90%, enabling teams to shift focus from manual prep to higher-value strategic tasks
- Audit follow-up costs reduced by 67%, driven by automation and centralized data management
- Data validation time decreased by 58%, thanks to high-speed scrubbing and intelligent error detection
- Subjectivity in audit reviews fell by 88%, with built-in compliance rules ensuring standardized, consistent validation
- 100% CMS audit success on first submission, with all universes passing without the need for resubmission or corrective follow-ups
With UMS, the provider transitioned to a proactive, audit-ready posture, backed by data integrity, faster turnaround, and lower compliance risk.