Claims, billing and eligibility audits. Stop paying for what you don’t owe.

Your plan pays invoices and claims every month, and errors add up quietly: coverage billed for people who left, dependents who are no longer eligible, claims paid outside the contract. Ethos Benefits audits billing against your records, reviews eligibility, coordinates claims audits with your vendors and tracks each recovery to completion.

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What you get.

Most invoices are paid as billed. Without a monthly check against your own records, overpayments can run for months before anyone notices.

Billing reconciliationCarrier and vendor invoices checked against your HR records and carrier enrollment, with each discrepancy listed and followed up.
Eligibility and dependent auditsEnrollment checked against plan eligibility rules, including dependent eligibility, with a plan to correct what doesn’t match.
Claims audit coordinationClaims audits arranged with your administrator or PBM under the audit rights in your contracts, with the findings reported to your committee.
Stop-loss reimbursement auditEvery eligible large claim checked for submission and payment under the stop-loss policy.
Fiduciary practices auditYour plan documents, committee record and vendor oversight reviewed against ERISA’s requirements, with the gaps prioritized.
Recovery trackingEvery overpayment and recovery tracked until it is resolved, and reported in your record.

What gets audited.

Audit	What it checks	How often
Billing reconciliation	Invoices against HR and carrier records	Monthly
Eligibility	Enrollment against plan rules, including dependents	Annually or at implementation
Claims	Claims paid against plan terms and contract pricing	Under your contract’s audit rights
Stop-loss	Reimbursements filed and paid	Throughout the policy year
Fiduciary practices	Documents, committee record and vendor oversight	Annually

Your right to audit.

An audit is only possible if the contract allows it. That is why audit rights are written into every contract during procurement, and why results are measured under vendor management.

Part of your Fiduciary Framework™.

Every Ethos service reports to your benefits committee. The work is reviewed at your quarterly committee meeting, each decision is recorded with the reasoning behind it, and the record lives in your Ethos Fiduciary OS. That is what lets your committee show the plan was run prudently.

See the Fiduciary Framework™ · How fiduciary governance works

Questions employers ask about this.

How often should invoices be audited?

Every month. Billing errors repeat until they are caught, so a monthly reconciliation catches them before they compound.

Can we audit our administrator or PBM?

If your contract allows it. Audit rights, including how often, with whose auditor and at whose cost, are negotiated during procurement so your plan can use them.

What is a dependent eligibility audit?

A review that confirms each covered dependent meets the plan’s eligibility rules, usually by asking employees for documentation. Removing ineligible dependents reduces claims the plan should not be paying.

See what your plan is really costing you.

A Strategic Analysis starts with your plan documents and your broker agreement, then shows you what your plan costs, where the risk sits, and what a committee would decide with the full picture.

Request a Strategic Analysis Call (407) 803-4710