Workflow Templates: claims auditing checklist

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

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

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

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

claims auditing checklist