insurance claims documentation checklist

Insurance Claims Documentation Checklist

 

Claims management systems represent an essential part of an insurer’s core system because it not only keeps track of all file activity in each claim but also gives claims professionals the ability to make the right claims decisions with ease. Each
aspect of the claim adjudication process is important, however, documenting all key claim activity is critical to each file to ensure proper outcomes.

Proper documentation is vital not only to record the facts and activity on a file, but it’s also the adjusters’ opportunity to back up their decision and the facts on damages, liability, coverage, etc.
Claim documentation should be approached with care; here are a few tips to keep in mind.

A documentation audit ensures proper practices are being followed

Making corrections, running audits, and proper training keeps employees following proper documentation procedures for each claim. Claim supervisors who perform regular quality assurance inspections help to not only track adjusters’ performance, but also create opportunities to improve and enhance their workflow process.

Take advantage of technology advancements to assist with the documentation

With the vendor landscape for insurance software technology being much more mature, Insurers have the ability to integrate applications for live call monitoring and recording. Sophisticated claim systems can also give claim professionals the options to transcribe calls, notify adjusters of potential issues in their claim, and track patterns.

keeping track of data electronically

Keep documentation clear and concise

All documentation should be straight to the point, leaving no room for interpretation. Keep logs of all phone calls and activities including negotiations and follow-up attempts.  Review all claim documentation with a fine-tooth comb. Diaries and notes should reflect the full story if any claim activity information is needed in a lawsuit.

Document how you came to your conclusion

Investigating each claim is an intricate process. Insurers are relied upon to provide credible evidence for both denials of claims, and awarding of coverage. Bad faith dealings accusations can come up when proper notes are not involved and claim professionals are not able to explain clearly how coverage was decided. Approaching claim documentation in an appropriate manner alleviates such a finding.

Good documentation skills are essential for claim professionals to practice daily. The diary system in your claims management software is a powerful tool to record adjusters’ notes, create reminders, and ensure effective management of each claim file. Keeping an updated diary system of supporting documentation that can be easily accessed by all parties involved will keep permanent storage of the data and eliminates the risk of loss.

document conclusion

If you’d like to read more about the subject, read our article series on Insurance Claims Documentation Checklist Part II and Part III.