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QA review (Desk)

Claimsfy Desk

The QA review tab (after Reports) checks the whole claim file before it goes out and gives it a score out of 100. Desk adjusters check their own files; supervisors review the team's.

  • State claim rules for the state where the loss is (all 50 states and DC), each with its citation:
    • Acknowledgment: the first contact against the state's acknowledgment deadline.
    • Decision: the first decision letter against the decision deadline, counted from the date reported or the proof of loss date, as the state's rule says.
    • Payment: the first approved payment against the payment deadline.
    • Status letters: whether they're in the file when a claim stays open without a decision.
    • Letters: every letter in the file, run through the letter review.
  • Carrier guidelines and estimate QA: whether the carrier's guidelines are on file (the Field Estimate Review library), the Claimsfy QA estimate score (▶ Run Claimsfy QA on Reports), and whether the carrier's letter wording is on file.
  • Estimate: whether there's one, whether the reserves cover it, depreciation to explain, and on water losses the mitigation review against the S500 water damage standard.
  • Coverage and documentation: the coverage position and whether it's confirmed, the policy on file, the date of loss against the policy period, late reporting, photos and captions, the inspection date, the claim notes (including the initial contact note), and the mortgagee on dwelling payments.
  • Review the file with Claimsfy AI reads the notice of loss, coverage, policy, estimate, reserves, payments, photo captions, notes and letters against the same state rules and the carrier's guidelines, and adds its findings with a score and a summary.
  • Open goes to the tab an item points to. ✓ Confirmed records that you checked an item; Doesn't apply asks why. Both are saved with your name and raise the score.
  • Save QA review keeps the result in the claim file, adds a QA review note and records it in History. ⬇ QA report downloads it as a PDF.
  • The state rules were researched October 16, 2026. The review is a checklist, not legal advice.