Claims procedures

The different procedures that are used to formally request a payment for a suffered loss from an insurance company.

case procedures
loss payment proceduces
loss case procedures

knowledge

sector-specific

Claims procedures is an essential knowledge of the following occupations:

Insurance claims handler: Insurance claims handlers ensure that all insurance claims are handled accurately and that payment for valid claims is made to the policyholders. They use statistical data and reporting to calculate and adjust claims as needed, communicate with and guide policyholders and monitor the progress of a claim.
Property insurance underwriter: Property insurance underwriters assess and determine the risk and coverage of a client’s property insurance. They analyse and review underwriting policies according to legal regulations.
Insurance agency manager: Insurance agency managers coordinate and oversee the operations of an institution or a branch of an institution that offers insurance services. They provide clients with advice on insurance products.
Insurance broker: Insurance brokers promote, sell and provide advice on various insurance policies such as life insurance, health insurance, accident insurance and fire insurance to individuals and organisations. They also work as intermediaries between individuals or organisations and insurance companies, and negotiate the best insurance policies for their clients, arranging insurance cover where needed. Insurance brokers engage with new prospective clients, provide them with quotes for their policy needs, assist them in the signing of new insurance contracts and propose specific solutions to their specific problems.
Insurance fraud investigator: Insurance fraud investigators combat fraudulent activities by investigating the circumstances of certain suspicious claims, activities related to new customers, buying insurance products and premium calculations. Insurance fraud investigators refer potential fraud claims to insurance investigators who then undertake research and investigations to support or deny a claimant’s case.
Loss adjuster: Loss adjusters treat and evaluate insurance claims by investigating the cases and determining liability and damage, in accordance with the policies of the insurance company. They interview the claimant and witnesses and write reports for the insurer where appropriate recommendations for the settlement are made. Loss adjusters’ tasks include making payments to the insured following his claim, consulting damage experts and providing information via telephone to the clients.
Insurance underwriter: Insurance underwriters assess business risks and liability policies and make decisions about commercial property. They inspect the conditions of businesses’ properties, analyse inspection policies, assist with real estate and rent issues, prepare loan contracts and handle commercial risks in order to align them with business practices. Insurance underwriters analyse various information from prospective customers in order to assess the likelihood that they will report a claim. They work to minimise risk for the insurance company and make sure that the insurance premium aligns with the associated risks. They can be specialists in life insurance, health insurance, reinsurance, commercial insurance, mortgage insurance.

Claims procedures is optional for these occupations. This means knowing this knowledge may be an asset for career advancement if you are in one of these occupations.

Insurance collector: Insurance collectors collect payment for an overdue insurance bill. They specialise in all areas of insurance such as medical, life, car, travel, etc and recurrently contact individuals to offer payment assistance or to facilitate payment plans according to individual’s financial situation.
Financial manager: Financial managers handle all the matters in reference to the finance and investments of a company. They manage financial operations of companies such as the assets, liabilities, equity and cash flow aiming to maintain the financial health of the company and operative viability. Financial managers evaluate the strategic plans of the company in financial terms, maintain transparent financial operations for taxation and auditing bodies, and create the financial statements of the company at the end of the fiscal year.
Insurance risk consultant: Insurance risk consultants prepare reports for insurance underwriters. For this purpose, they undertake surveys in order to determine the potential financial risk for personal products, properties or sites.

References

1. Claims procedures – ESCO