AUDIT OBJECTIVES:

1. Timely communication of claims to the Insurer.

2. Claims submitted as per policy and procedure defined by Insurer.
3. Claim Receipts are accurate.
4. Claim amount received as per policy and properly authorized.
5. The regularly updating Insurance limits for the year/period.
6. Pending claim reports.
7. Justification for Rejected cases.
8. Over/under payment by insurance and difference adjustments.

AUDIT PROCEDURES:
Work paper
Performed
Procedure Reference
by
(WP Ref)
1 Timely communication of claims to the Insurer.
a Ensure that 3 point contacts have been made timely.
Select a judgmental sample to ensure that initial
b investigation and Surveys are performed in a timely
manner.
Claims submitted as per policy and procedure defined by
2
Insurer.
Ensure that the claims are submitted as per policy and
a
procedure given by insurance company.
3 Claim Receipts are accurate.
Review the claim reports to confirm the amount received
a
from insurance company in the bank statement is correct.
Claim amount received as per policy and properly
4
authorized.
Reconcile the claim reports with initial investigation and
a survey reports to check whether the claim amount is
received as per policy.
The regularly updating Insurance limits for the
5
year/period.
Ensure that insurance coordinating department is updating
a claim amount against the limits defined by insurance
company for the year/period.
6 Pending claim reports.
Review the most recent weekly Pending Claims file to
a ensure that there are no claims in pending status to the
insurance company for more than specified days.
 Review follow up of pending claims to identify the reason
b
of delay.
7 Justification for Rejected cases.
Review claim reports of rejected claims to identify the
a
reason of rejected claims.
Ensure that the rejected claims are rejected as per defined
b
policy of insurance company.
Over/under payment by insurance and difference
8
adjustments.
Review the claim reports of over/under payments to
a
identify the total amount to be adjusted.
Ensure that the adjustment is treated correctly with
b
Insurance company’s Financials.

Remarks:

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Performed by: ______________________________________________ Date: ___________

Reviewed and approved by: ____________________________________ Date: ___________