Competency Details ( Claims Management )

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Competencies

Jadarat Competencies

Claims Management

Efficiency Technical Competency

Is responsible for managing the claims team and overseeing the efficient execution of claims procedures, processes and cost management. Evaluates the performance of claims function, processes and procedures and service standards, and proposes changes for improvement. Builds overall customer experience by conducting customer feedback analysis to ensure the achievement of high standards for the claims operations.

Jadarat Code: T13

Level 1

Demonstrates basic understanding of own organisation’s relevant processes, procedures, and service standards that are related to claims management. Has basic knowledge of the identification of financial monitoring techniques. Understands the internal processes to follow for meeting customer claims service standards.

Level 2

Supports the team in the efficient execution of claims procedures, processes and cost management. Uses specialised knowledge and understanding of the various techniques used for claims expenses management. Possesses specialised knowledge of customer claims service standards, and seeks relevant information from the customers to understand their concerns and expectations.

Level 3

Assists others across the teams in managing the claims procedures and multiple claims costs, to ensure that customer claims' service standards and customer expectations are met. Uses the tools and techniques to support in monitoring claims leakage and identifying claims that appear to be fraudulent, and follows the organizational protocols of referral for dealing with such claims.

Level 4

Develops and oversees the organization's claims management procedures, processes and cost management. Recommends and justifies the need for new/improved methods for efficient claims management. Analyses currently-followed methods for claims leakage monitoring and reviews customer feedback to ensure the achievement of high standards for claims operations and build good customer experience.

Level 5

Applies subject matter expertise to define the organization's claims management strategy and guidelines, in compliance with the applicable laws and regulations. Evaluates current procedures, processes and cost management techniques to ensure their effectiveness; recommends and drives necessary process improvements to control fraud and other forms of claims leakage, and build good customer experience.