File Quality Audit
Every closed claim file tested against your best practices and state rules, not a small sample.
Why it matters
Quality teams audit a small sample of files by hand; missed deadlines, unsupported payments and missed recoveries in the rest surface in market conduct exams.
How the solution handles it
Six agents assemble the full file, rebuild its timeline, test every clock and step against state rules and your best practices, check payments and look for missed recoveries, then score the file with every finding cited. The quality assurance lead confirms each finding.
How a file audit moves
Six specialist agents rebuild each file’s timeline and test it against your rules; the quality assurance lead confirms every finding.
What it reads, and what it hands back.
What goes in
- Closed claim files and notes
- Letters and payment records
- Best-practice checklists
- State claim-handling rules
What comes out
- File quality scorecard
- Missed-clock and leakage findings
- Coaching notes by adjuster
- Market conduct evidence pack
Who uses it
The difference, in numbers.
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
Source: NAIC Market Regulation Handbook (claims standards) · “Target” = design goal, measured in the live solution · agents = the live solution’s configuration
6 specialist agents. One person decides.
More in this division.
Every first notice of loss read, scored and routed to the right adjuster within the hour.
Coverage LettersEvery coverage question answered from the policy wording, with a cited letter drafted for counsel.
Reserve ReviewEvery open claim’s reserve tested against its file each quarter, with gaps explained before anyone asks.
Build this
for your team.
We’ll show File Quality Audit running on your own documents.