Job Family Card - Claims

Handle claims for the organization. This involves the negotiation and settlement of claims. Roles in this function may be responsible for single- or multi-country claims and will be responsible for all aspects of claims from first advice through to final settlement. Provide claims services in respect of claims for compensation, restitution, repayment or any other remedy for loss or damage, or in respect of some other obligation. Also, they will liaise with external professionals.

Job Family Code

ICL

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Job Roles

Card Job Role Description

Job Role

Claims associate

Job Family Code

ICL

Job Family

Claims

Responsibilities

    Gather claim and claimant details in accordance with organization's the procedures and verify the accuracy and completeness of the documents provided.

    Provide advice on making a claim and the processes involved.

    Initiate process of approved payments to claimants and prepare the payment instructions according to organization's procedures.

    Record the claim and claimant data and information into claims management systems.

Card Job Role Description

Job Role

Claims Investigator

Job Family Code

ICL

Job Family

Claims

Responsibilities

    Investigate potential fraudulent activity and examine suspicious claims closely for evidence of fraud.

    Educate organisation's adjusters and examiners to look for "red flags", or indicators that fraud might be occurring.

    Investigate suspicious claims and gather accident information and interview witnesses.

    Assess factual information on the accident and history and background information of the claimant.

    Liaise with police inspectors, lawyers and other stakeholders on the case being investigated.

Card Job Role Description

Job Role

Claims Handler

Job Family Code

ICL

Job Family

Claims

Responsibilities

    Compares claims details against policy conditions and requirements to identify out of scope claims.

    Process claims and reserving policy to determine the claims estimated indemnification.

    Liaise and get advice from specialists, such as loss adjusters and forensic accountants, on complex cases.

    Maintain and use the computerized claims/loss recording system to collate claims statistics/data for proper risk analysis and management reporting.

    Provide support in preparing own organization claims to the re-insurance company.

Card Job Role Description

Job Role

Claims Investigation Supervisor

Job Family Code

ICL

Job Family

Claims

Responsibilities

    Monitor the investigation of suspicious insurance claims for different types of policies.

    Contribute to the development of the claims special investigation processes and procedures.

    Identify verification means for the factual information and circumstances of the accident.

    Ensure proper police reporting in case of fraud and that legal procedures are in place.

    Supervise investigators and insure they adhere to professional code of conduct and have the required training.

Card Job Role Description

Job Role

Senior Claims Specialist

Job Family Code

ICL

Job Family

Claims

Responsibilities

    Negotiating the settlement of the organization's material loss claims according to claims management policies and procedures while monitoring reserves.

    Ensure claims are raised according to policy's terms and benefits ensuring fair settlement of a valid claim.

    Guide claims procedure and related risk analysis and investigation procedures.

    Administer claims and ensure claims processes are implemented efficiency.

    Prepare analysis reports and claims activity reviews.

Card Job Role Description

Job Role

Claims Investigation Unit Manager

Job Family Code

ICL

Job Family

Claims

Responsibilities

    Develop and oversee the implementation of the investigation unit policy and procedures.

    Develop and manage suspicious claims and guide, technically, the investigation team through the proper procedure.

    Develop claims investigation tools and identify techniques to be applied within the claims investigation unit.

    Coordinate with internal and external stakeholders and ensure proper reporting of claims investigation results.

    Ensure that all claims investigation procedures are conducted in compliance with regulatory requirements and according to best practice.

Card Job Role Description

Job Role

Claims Technical Manager

Job Family Code

ICL

Job Family

Claims

Responsibilities

    Develop and improve insurance claims management strategy and procedures and contribute to setting the organisation's reserves strategy.

    Manage claims function via the various suppliers in a cost-effective manner and assist the divisions in identifying ways to reduce claim numbers and average value.

    Provide claims advice guidance and education as required throughout the organization to assist with the mitigation of risk.

    Manage large complex claims liaising claims handlers, loss adjusters as well as the claimants.

    Review the liabilities of insurance policies and investigate claims to determine payable amounts based on coverage and guidelines.

Card Job Role Description

Job Role

Head of Claims

Job Family Code

ICL

Job Family

Claims

Responsibilities

    Contribute to the formulation of the overall organization's strategy, in collaboration with others in the executive team, focussing the organization's Claims function.

    Approve and ensure implementation of Claims function policies and procedures and ensure its efficiency.

    Manage Claims function and ensures its compliance to regulatory requirements as well as market Standards.

    Manage and monitor Claims function budget for cost efficiency.

    Manage internal and external relationships and represent the organisation in all business matters related to Claims function.

    Take the special investigation decision and ensure that potential fraud is flagged, investigated and perpetrators are revealed.

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