Insurance claims manager

Description

Insurance claims managers lead the team of insurance claims officers to ensure they handle insurance claims properly and efficiently. They deal with more complex customer complains and assist with fraudulent cases. Insurance claims managers work with insurance brokers, agents, loss adjusters and customers.

Other titles

The following job titles also refer to insurance claims manager:

claims manager
insurance claim supervisor
insurance claims coordinator
insurance claims administrator
claims director
head of insurance claims office
insurance and claims manager
insurance claims service manager
insurance claims director

Minimum qualifications

High school diploma is generally required to work as insurance claims manager. However, this requirement may differ in some countries.

ISCO skill level

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 manager is a Skill level 4 occupation.

Insurance claims manager career path

Similar occupations

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

insurance product manager
insurance agency manager
credit union manager
relationship banking manager
fundraising manager

Long term prospects

These occupations require some skills and knowledge of insurance claims manager. 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 manager with a significant experience and/or extensive training.

Essential knowledge and skills

Essential knowledge

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

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.
Financial statements: The set of financial records disclosing the financial position of a company at the end of a set period or of the accounting year. The financial statements consisting of five parts which are the statement of financial position, the statement of comprehensive income, the statement of changes in equity (SOCE), the statement of cash flows and notes.
Financial management: The field of finance that concerns the practical process analysis and tools for designating financial resources. It encompasses the structure of businesses, the investment sources, and the value increase of corporations due to managerial decision-making.
Fraud detection: The techniques used to identify fraudulous activities.
Corporate social responsibility: The handling or managing of business processes in a responsible and ethical manner considering the economic responsibility towards shareholders as equally important as the responsibility towards environmental and social stakeholders.
Financial analysis: The process of assessing the financial possibilities, means, and status of an organisation or individual by analysing financial statements and reports in order to make well informed business or financial decisions.
Principles of insurance: Understand the principles of insurance, including third party liability, stock and facilities.
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.

Essential skills and competences

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

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.
Enforce financial policies: Read, understand, and enforce the abidance of the financial policies of the company in regards with all the fiscal and accounting proceedings of the organisation.
Analyse market financial trends: Monitor and forecast the tendencies of a financial market to move in a particular direction over time.
Strive for company growth: Develop strategies and plans aiming at achieving a sustained company growth, be the company self-owned or somebody else’s. Strive with actions to increase revenues and positive cash flows.
Manage staff: Manage employees and subordinates, working in a team or individually, to maximise their performance and contribution. Schedule their work and activities, give instructions, motivate and direct the workers to meet the company objectives. Monitor and measure how an employee undertakes their responsibilities and how well these activities are executed. Identify areas for improvement and make suggestions to achieve this. Lead a group of people to help them achieve goals and maintain an effective working relationship among staff.
Prepare financial auditing reports: Compile information on audit findings of financial statements and financial management in order to prepare reports, point out improvement possibilities, and confirm governability.
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.
Advise on financial matters: Consult, advise, and propose solutions with regards to financial management such as acquiring new assets, incurring in investments, and tax efficiency methods.
Conduct financial audits: Evaluate and monitor the financial health, the operations and financial movements expressed in the financial statements of the company. Revise the financial records to ensure stewardship and governability.
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.
Lead claim examiners: Select claim examiners and assign them to cases, assist them and give them advice or information when needed.
Plan health and safety procedures: Set up procedures for maintaining and improving health and safety in the workplace.
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.
Liaise with managers: Liaise with managers of other departments ensuring effective service and communication, i.e. sales, planning, purchasing, trading, distribution and technical.
Follow company standards: Lead and manage according to the organisation’s code of conduct.
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.

Optional knowledge and skills

Optional knowledge

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

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.

Optional skills and competences

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

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.
Handle customer complaints: Administer complaints and negative feedback from customers in order to address concerns and where applicable provide a quick service recovery.
Recruit employees: Hire new employees by scoping the job role, advertising, performing interviews and selecting staff in line with company policy and legislation.
Create a financial plan: Develop a financial plan according to financial and client regulations, including an investor profile, financial advice, and negotiation and transaction plans.
Initiate claim file: Start the process to file a claim for a customer or victim, based on the judgement of the damage and the responsibilities of the parties involved.
Manage financial risk: Predict and manage financial risks, and identify procedures to avoid or minimise their impact.
Analyse financial performance of a company: Based on accounts, records, financial statements and external information of the market, analyse the performance of the company in financial matters in order to identify improvement actions that could increase profit.
Ensure cross-department cooperation: Guarantee communication and cooperation with all the entities and teams in a given organisation, according to the company strategy.
Assess customer credibility: Communicate with customers to assess whether their true intentions are in line with what they claim in order to eliminate any risks from a potential agreement with the customer.
Apply technical communication skills: Explain technical details to non-technical customers, stakeholders, or any other interested parties in a clear and concise manner.
Create insurance policies: Write a contract that includes all the necessary data, such as the insured product, the payment to be made, how often the payment is needed, the personal details of the insured and on what conditions the insurance is valid or invalid.
Estimate damage: Estimate damage in case of accidents or natural disasters.
Analyse insurance risk: Analyse the probability and size of the risk that is to be insured, and estimate the value of movable or immovable property of the client.
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.
Handle financial disputes: Handle disputes between individuals or organisations, either public or corporate, which deal with financial matters, accounts, and taxation.
Manage contract disputes: Monitor issues that arise between the parties involved in a contract and provide solutions in order to avoid lawsuits.

ISCO group and title

1346 – Financial and insurance services branch managers

 

 


 

 

References
  1. Insurance claims manager – ESCO
Last updated on August 8, 2022

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