Competency Details ( Claims Handling )

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Competencies

Jadarat Competencies

Claims Handling

Efficiency Technical Competency

Effectively handles the claims process and settlement procedures according to set requirements; reviews and evaluates routine and non-routine claims and executes claim procedures as defined by the policy; communicates with stakeholders and other third parties on the status of their claims and prepares management reports on the issues or findings.

Jadarat Code: T11

Level 1

Demonstrates basic understanding of the organization’s processes and procedures related to claims processing and settlement. Has basic knowledge of the identification of the key pieces of information required at the time of the notification of a claim, and is able to initiate simple communications and reports on routine claims.

Level 2

Understands the process of notifying policyholders with findings and regular updates regarding the progress and status of their claims. Builds on specialised knowledge and understanding of the various techniques used to resolve minor disputes around claims settlement, and when such techniques are used for non-routine claims.

Level 3

Deeply understands the context and all aspects of claims settlement, processes claims and issues settlement document when appropriate and in accordance with the organization's claims processing procedures. Utilizes deep understanding of the techniques used for monitoring, reviewing and evaluating the claims payment processes, and investigates any payment discrepancies.

Level 4

Develops and oversees the organization's claims processing and settlement procedures. Provides expertise in monitoring and evaluating the current methods and systems of claims payment handling. Recommends and justifies the need for new/improved methods and systems for payment processing and handling for complex claims.

Level 5

Applies subject matter expertise in compliance with the applicable laws and regulations, to define the organization's claims handling strategy and guidelines. Reviews the claims processing and settlement procedures to ensure their effectiveness, and recommends and drives improvements as necessary.