Assign Audit Service Claim
TYPE OF LOSS
*
WATER MIT
MOLD
PACKOUT
BIO
FIRE / SMOKE
ABATEMENT
Source of Loss:
CARRIER ADJUSTER INFORMATION
Insurance Co:
*
Name:
*
Email:
*
Phone:
*
Please enter a valid phone number.
Format: (000) 000-0000.
IN REFERENCE TO
Claim #:
*
Date of Loss:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Insured:
*
Insured Phone:
Please enter a valid phone number.
Format: (000) 000-0000.
Contractor:
Contractor Phone:
Please enter a valid phone number.
Format: (000) 000-0000.
Contractor Contact Name:
Contractor Contact Phone:
Please enter a valid phone number.
Format: (000) 000-0000.
Contractor Email:
example@example.com
Loss Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
NEW ASSIGNMENT DIRECTIVE
Type a question
*
Provide Comparative Estimate
Obtain Document from XactAnalysis
Contact Vendor to Negotiate
Obtain Records from Vendor
Contact Adjuster to Review
Audit Only - Do Not Negotiate
Other
ADDITIONAL INSTRUCTION / INFORMATION
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