All case studies reflect real audit engagements. Details have been anonymized to protect client confidentiality.

Case Study 1: Dependent Eligibility Audit – Mid-Size Employer

Client Profile
Organization Type: Mid-Size Employer
Population Size: Employee and dependent population (health benefits)
Audit Type: Dependent Eligibility Audit

The Challenge
The employer had not conducted a dependent eligibility audit in several years. Dependent enrollment data had carried forward through multiple open enrollments and operational changes, creating uncertainty around eligibility accuracy and ongoing cost exposure.
The organization wanted to validate dependent eligibility while minimizing disruption to employees and maintaining trust in the benefits program.

Audit Approach
A structured, employee-friendly audit process was implemented, beginning with clear plan rule validation and eligibility criteria.
The audit approach emphasized:
• Transparent employee communications outlining eligibility rules
• Reasonable documentation requirements
• Secure handling of sensitive dependent information
• Consistent review standards and documented determinations
• Ongoing status tracking through a project-managed delivery model

Results & Outcomes
The audit identified:
• Dependents enrolled who no longer met plan eligibility requirements
• Missing or insufficient documentation for certain dependents
• Opportunities to improve enrollment controls and data accuracy
As a result, the employer:
• Removed ineligible dependents from coverage
• Improved accuracy of dependent enrollment records
• Reduced unnecessary premium and claims exposure
• Strengthened confidence in benefits administration practices

Why It Mattered
This audit reinforced that dependent eligibility audits are not punitive exercises, but essential governance tools. By applying plan rules consistently and respectfully, the employer protected benefit integrity, improved data quality, and ensured fairness for all plan participants—without eroding employee trust.

Case Study 2: Retiree Eligibility Audit – Large Employer

Client Profile
Organization Type: Large Employer
Population Size: 3,000+ retirees
Audit Type: Retiree Spending Account Eligibility Audit

The Challenge
A large employer offering a retiree special monetary benefits spending account needed to confirm eligibility across a population of more than 3,000 retirees. To qualify for the subsidy, retirees were required to meet specific eligibility criteria established by the employer’s benefit program, unless they were already covered under the employer’s retiree medical plan.
The employer lacked clear visibility into eligibility status across the retiree population and wanted to ensure the program was being administered accurately, compliantly, and in alignment with plan rules.

Audit Approach
The audit began with a structured discovery and scoping phase to define eligibility requirements, documentation standards, communication cadence, and data sources. Key elements of the approach included:
• Clear retiree communications explaining eligibility and documentation requirements
• Secure collection and review of eligibility documentation
• Address validation and follow-up outreach for non-responsive participants
• Project-managed execution to track progress, risks, and outcomes

Results & Outcomes
By the conclusion of the audit:
• 500 retirees enrolled in the employer retiree medical plan were automatically approved
• 1,500 retirees were confirmed eligible through documentation review
• 700 retirees were denied due to ineligibility or failure to meet documentation requirements
• 45 deceased individuals were identified and removed from the population
• 170 records were flagged for inaccurate or outdated mailing addresses

Why It Mattered
The audit delivered more than eligibility confirmation. It surfaced ineligible and deceased participants, improved retiree data integrity, and provided the employer with clear insight into population risk and compliance gaps. Most importantly, the audit aligned spending account subsidies with true eligibility—resulting in meaningful cost avoidance and greater confidence in retiree benefits administration.

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