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.

Insurance claims handlers typically do the following duties:

• take details when a customer reports a claim
• issue claim forms
• give advice on the claims process
• check insurance claims
• make sure premiums have been paid and that policies cover the claim
• gather information like receipts, photographs or valuations
• arrange payments on straightforward claims

The following job titles also refer to insurance claims handler:

claims handler
contract claims examiner
claims consultant
claims representative
property and casualty insurance claims examiner
claims inspector
claims service supervisor
insurance claims consultant
claims examiner
claims processor
insurance claims officer
casualty insurance adjuster
claims adjuster
insurance claims analyst
travelling insurance assessor
insurance claims processor
claims analyst
insurance claims assessor
insurance claims examiner
civil damages inspector
insurance claims inspector

Insurance claims handlers usually work in an insurance office or contact centres. Sometimes, they may need to travel to visit clients, brokers and solicitors. Most work, however, is done at a desk using a computer and speaking on the phone. The job involves working to tight deadlines, working under pressure and using technology.

A bachelor’s degree in accounting and/or finance, business or management/business with languages, economics and accountancy, law, or mathematics is recommended to become an insurance claims handler, although this area of work is open to all graduates.

ISCO skill level is defined as a function of the complexity and range of tasks and duties to be performed in an occupation. It is measured on a scale from 1 to 4, with 1 the lowest level and 4 the highest, by considering:

• the nature of the work performed in an occupation in relation to the characteristic tasks and duties
• the level of formal education required for competent performance of the tasks and duties involved and
• the amount of informal on-the-job training and/or previous experience in a related occupation required for competent performance of these tasks and duties.

Insurance claims handler is a Skill level 3 occupation.

These occupations, although different, require a lot of knowledge and skills similar to insurance claims handler.

insurance fraud investigator
property insurance underwriter
loss adjuster
insurance risk consultant
pensions administrator

These occupations require some skills and knowledge of insurance claims handler. They also require other skills and knowledge, but at a higher ISCO skill level, meaning these occupations are accessible from a position of insurance claims handler with a significant experience and/or extensive training.

insurance claims manager
actuarial consultant
bankruptcy trustee
insurance rating analyst
insurance agency manager

This knowledge should be acquired through learning to fulfill the role of insurance claims handler.

• Insurance law: The law and legislation concerning the policies of transferring risks or losses from one party, the insured, to another, the insurer, in exchange for a periodic payment. This includes the regulation of insurance claims and the business of insurance.
• Fraud detection: The techniques used to identify fraudulous activities.
• Principles of insurance: Understand the principles of insurance, including third party liability, stock and facilities.
• Actuarial science: The rules of applying mathematical and statistical techniques to determine potential or existing risks in various industries, such as finance or insurance.
• Claims procedures: The different procedures that are used to formally request a payment for a suffered loss from an insurance company.
• Types of insurance: The various types of risk or loss transfer policies that exist and their characteristics, such as health insurance, car insurance or life insurance.

These skills are necessary for the role of insurance claims handler.

• Manage claim files: Follow up on the progress of a claim file, keep all parties informed of the status of the file, ensure the customer receives the damages owed, treat any problems or complaints from customers, close the file and give information to an authorised person or department when there is suspicion of fraud.
• Analyse claim files: Check the claim from a customer and analyse the value of the lost materials, buildings, turnover or other elements, and judge the responsibilities of the different parties.
• Review insurance process: Analyse all documentation related to a specific insurance case in order to ensure that the application for insurance or the claims process was handled according to guidelines and regulations, that the case will not pose significant risk to the insurer or whether claims assessment was correct, and to assess the further course of action.
• Synthesise financial information: Collect, revise and put together financial information coming from different sources or departments in order to create a document with unified financial accounts or plans.
• Maintain records of financial transactions: Collate all the financial transactions done in the daily operations of a business and record them in their respective accounts.
• Communicate with beneficiaries: Communicate with individuals or organisations who are entitled to receive benefits in the form of funds or other rights in order to obtain information on the procedures, to ensure that beneficiaries receive the benefits they are entitled to, and to provide further information.
• Calculate compensation payments: Calculate the amount due by the insurance company in case of a legitimate claim, authorise the financial transfer and address reclamations to other insurance companies if needed.
• Handle incoming insurance claims: Manage, process and evaluate submitted requests for insurance in case a problem, which is covered under an insurance policy, occurs. The claim may or may not be approved, based on assessment of the circumstances.
• Apply technical communication skills: Explain technical details to non-technical customers, stakeholders, or any other interested parties in a clear and concise manner.
• Provide financial product information: Give the customer or client information about financial products, the financial market, insurances, loans or other types of financial data.
• Classify insurance claims: Process incoming claims in order to assess their nature and categorise them according to the different types of insurance and claims handling procedures, in order to ensure proper administrative handling, and to guarantee that the claim may proceed to the correct loss adjuster or other claims professionals.
• Interview insurance claimants: Interview people who have filed claims with the insurance corporation they are insured with, or through specialised insurance agents or brokers, in order to investigate the claim and the coverage in the insurance policy, as well as detect any fraudulous activities in the claims process.
• Organise a damage assessment: Organise a damage assessment by indicating an expert to identify and examine the damage, give information and instructions to experts and follow up on the experts, and write a damage report.

This knowledge is sometimes, but not always, required for the role of insurance claims handler. However, mastering this knowledge allows you to have more opportunities for career development.

• Statistics: The study of statistical theory, methods and practices such as collection, organisation, analysis, interpretation and presentation of data. It deals with all aspects of data including the planning of data collection in terms of the design of surveys and experiments in order to forecast and plan work-related activities.
• Insurance market: The trends and major driving factors in the insurance market, insurance methodologies and practices, and the identification of the major stakeholders in the insurance sector.

These skills and competences are sometimes, but not always, required for the role of insurance claims handler. However, mastering these skills and competences allows you to have more opportunities for career development.

• Trace financial transactions: Observe, track and analyse financial transactions made in companies or in banks. Determine the validity of the transaction and check for suspicious or high-risk transactions in order to avoid mismanagement.
• Handle customer complaints: Administer complaints and negative feedback from customers in order to address concerns and where applicable provide a quick service recovery.
• Apply statistical analysis techniques: Use models (descriptive or inferential statistics) and techniques (data mining or machine learning) for statistical analysis and ICT tools to analyse data, uncover correlations and forecast trends.
• Decide on insurance applications: Assess applications for an insurance policy, taking into account the risk analyses and client information, in order to deny or approve the application and set in motion the necessary procedures following the decision.
• Ensure cross-department cooperation: Guarantee communication and cooperation with all the entities and teams in a given organisation, according to the company strategy.
• Manage claims process: Manage the relation with an insurer related to its obligation to receive, investigate and act on a claim filed by an insured.
• Estimate damage: Estimate damage in case of accidents or natural disasters.
• Analyse financial risk: Identify and analyse risks that could impact an organisation or individual financially, such as credit and market risks, and propose solutions to cover against those risks.
• Assess coverage possibilities: Examine the reports dealing with damage appraisal or injury examination in order to verify whether the insured’s damages or injuries are covered in their insurance policies, and if they are to assess to which extent they are covered and what settlements the insurer may have to provide.
• Handle financial disputes: Handle disputes between individuals or organisations, either public or corporate, which deal with financial matters, accounts, and taxation.
• Handle financial transactions: Administer currencies, financial exchange activities, deposits as well as company and voucher payments. Prepare and manage guest accounts and take payments by cash, credit card and debit card.

3315 – Valuers and loss assessors

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References

1. Insurance claims handler – ESCO
2. Insurance claims handler | Explore careers – National Careers Service
3. Insurance claims handler job profile | Prospects.ac.uk
4. Featured image: Photo by Mikhail Nilov from Pexels