What is the main goal of adjudication in the claims process?

The primary goal of adjudication in the claims process is to determine if the claim should be paid and the amount of that payment. This step is critical as it involves a thorough review of the claim's details, including the circumstances, evidence provided, policy coverage, and any applicable regulations. During the adjudication phase, adjusters assess the validity of the claim, ensuring that it aligns with the terms established in the insurance policy.

This process involves analyzing the information to not only approve or deny the claim but also to calculate the accurate payout based on the insured loss. Therefore, effective adjudication helps ensure that legitimate claims are processed correctly and fairly, while also preventing fraudulent claims from being paid out.

Options that focus on evaluating fraud indicators, assigning claims to adjusters, or speeding up the payment process, while relevant to the broader claims management workflow, do not encapsulate the core purpose of adjudication itself, which centrally involves the decision-making on payment eligibility and amounts.