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Effective Claim Audits

How should we best think about achieving high-quality outcomes through best-practices file-handling and an effective audit process? Here is a model.

By Jay Campbell | Updated on November 04, 2009
The objective for any claim-paying organization is to strike the right balance in making good on the promise made by the coverage that was sold: Indemnify and make whole the insured as quickly and efficiently as possible.

Anyone purchasing an insurance policy is doing so with the idea that someday a loss will occur, and a claim will be submitted. Given that very few policyholders actually read their policies — and those that do tend to not fully understand all the coverages — it’s no surprise that once a loss happens, the insured often finds himself in uncharted waters with not much to go on.

Enter the claim adjuster. Their job is to evaluate the loss, manage outside experts, apply coverage, negotiate and settle with the insured, pay the claim, and close the file. While they are at it, they are to use experience to identify potential fraud, and recovery opportunities — all this while supervisors coach and auditors provide feedback.

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