Claims Assessment Accuracy Audit Form
Use this form to systematically review and rate the accuracy of processed claims. Please complete all sections for a thorough audit record.
Auditor Name
*
First Name
Last Name
Auditor Email Address
*
example@example.com
Date of Audit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Claim Number
*
Date of Claim
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Claim Type
*
Please Select
Health
Property
Auto
Travel
Other
Assessment Criteria
*
Rows
Excellent
Good
Fair
Poor
Claim documentation completeness
1
2
3
4
Accuracy of data entry
5
6
7
8
Adherence to policy guidelines
9
10
11
12
Timeliness of claim processing
13
14
15
16
Correctness of claim decision
17
18
19
20
Were all required supporting documents attached?
*
Yes
No
Partially
Overall rating for this claim assessment
*
1
2
3
4
5
Audit Findings and Comments
Recommendations or Corrective Actions (if any)
Submit Audit
Should be Empty: