Paying a claim that should have been declined costs an insurer money, and that cost reaches every honest policyholder. Agisanang’s Claims Validation service reviews claims independently before payment, checking that they are genuine, within cover and correctly valued. We work with insurers and financial institutions that need a second set of eyes on claims, at volume and with clear reporting.

What we validate

• Policy status: Was the policy in force, and were premiums up to date at the date of loss?
• Cover and exclusions: Does the loss fall within the policy terms, and does any exclusion apply?
• Waiting periods and conditions: Have the policy’s waiting periods and conditions been met?
• Claimant and beneficiary: Is the person claiming entitled to the benefit, and are their details correct?
• Documentation: Are the documents complete, consistent and credible?
• Claim value: Is the amount claimed supported by quotes, invoices, assessor reports or certificates?
• Red flags: Do patterns, inconsistencies, repeat claims or timing call for further investigation?
• Calculation: Is the settlement amount correctly calculated against the policy terms?

Types of claims we validate

• Credit life and loan protection claims
• Funeral and death benefit claims
• Motor and property claims
• Disability and other benefit claims

How it works

1. Claims are referred to Agisanang through agreed channels.
2. Our validators review each claim against the policy and supporting evidence.
3. Where something does not add up, we query it with the claimant or refer it for investigation.
4. We return a documented outcome: validated, queried or recommended for decline, with reasons.
5. We report on volumes, outcomes and trends.

What you get

• A documented outcome and reasons for every claim reviewed
• Consistent application of the policy and your rules
• Reporting on validation volumes, outcomes and common issues
• Faster payment of genuine claims, because the file has already been checked

Who it’s for

Insurers, banks and financial institutions with high claim volumes, credit life portfolios or outsourced claims processes.

What we need to start

• The policy wordings and claims rules to validate against
• The referral channel and format for claims
• The outcome categories and reporting you want
• Escalation contacts for queries

Questions you may have

Do you pay claims? No. We validate and report. The insurer or institution makes the payment decision.

Can you handle large volumes? Yes. AGI Online is built for high claim volumes.

What happens when a claim looks suspicious? We query it, and where warranted refer it for investigation, with the reasons recorded.

Why choose Agisanang for claims validation

• Independent review: A validator with no stake in the outcome.
• Documented decisions: Every outcome has reasons that can be explained.
• Built for volume: The process holds up when claim numbers rise.
• Fair to honest claimants: Valid claims move faster when the file is already checked.

Pay what is owed. Question what is not.

Call to action: Contact Agisanang to discuss claims validation for your portfolio.

Related pages: Claims Administration, Credit Life Insurance, Funeral Cover, CRM & Reporting.