Competency Details ( Claims Investigation )

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Financial Skills Framework

Skills Dictionary

Claims Investigation

Technical Skills

Assesses and investigates technical claims, and manages the disputed claims or those involving litigation. Uses logical and analytical thinking when investigating and processing claims, and negotiates with those concerned on the outcome of their claims under investigation.

Skill Code: T003

Level 1

Demonstrates a basic understanding of the considerations given to the assessment and investigation of technical claims. Has basic knowledge of the identification of the key pieces of information required at the time of claim investigation, and is able to initiate simple communications and reports on the claims that are under investigation.

Level 2

Builds on specialised knowledge and understanding of the various techniques used for the investigation of technical claims, and the management of the disputed claims or those involving litigation. Understands the process of notifying the relevant stakeholders with the outcomes of their claims under investigation.

Level 3

Utilizes deep understanding of the required techniques to assess, investigate and manage any potential suspicions related to the claims being processed. Compiles relevant information concerning the claims under investigation and shares them with the involved claim handlers for further processing and judgement.

Level 4

Develops and oversees the organization’s claims’ investigation procedures. Provides expertise in determining the validity of claims under investigation. Makes quick judgement on the investigated claims. Recommends and justifies the need for new/improved methods for claims’ investigation, and the management of disputed claims or those involving litigation. Negotiates with the concerned stakeholders on the outcome of their claims under investigation.

Level 5

Applies subject matter expertise in the development of the claims’ investigation strategy and guidelines, in compliance with the applicable laws and regulations. Makes quick judgement on the investigated claims and reviews the claims investigation procedures to ensure their validity and effectiveness, and recommends and drives improvements as necessary.