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claims auditing checklist
Claim Submission Review
Verify claim form completeness and accuracy
Check for required supporting documentation
Confirm policyholder information and coverage details
Assess claim for potential red flags or fraud indicators
Ensure claim is submitted within policy time limits
Documentation and Verification
Validate the authenticity of supporting documents
Check the consistency of information across all documents
Confirm the date and time of the reported incident
Review previous claims history of the policyholder
Ensure compliance with legal and regulatory requirements
Claim Evaluation and Approval
Assess the validity of the claim based on policy terms
Determine the appropriate payout amount
Review the claim for any exclusions or limitations
Consult with specialists or adjusters if necessary
Approve or deny the claim and record the decision
Communication and Follow-Up
Notify the policyholder of the claim decision promptly
Provide detailed explanation for claim approval or denial
Address any inquiries or disputes from the policyholder
Arrange for payment processing if the claim is approved
Schedule a follow-up to ensure customer satisfaction
