Well-qualified with proven success in improving operations and solving problems. Highly proficient in building lasting relationships with key decision makers, customers and team members to further company goals. Ready to leverage training and experience to take on new professional challenges.
providing advice on making a claim and the processes involved;
processing new insurance claims notifications;
collecting accurate information and documents to proceed with a claim;
where possible / appropriate obtain check the validity of the information provided by the claimant, consultants and other sources;
interpretation of the policy wording and policy schedule to determine the extent of coverage and the application of any warranties, conditions or exclusions.
The identification and collection of any policy excess/deductibles.
analysing the claim made by a policy holder or third party;
guiding policyholders on how to proceed with the claim;
arguably the claims officer does not have the same duty to a third party as they do to a premium paying customer of their employer, the insurer. Having said this they still ought to show respect, compassion and integrity to achieve a reasonable settlement and protect the brand of the insurer;
contacting people from a network of approved professionals ranging from repairers to lawyers, loss adjusters and medical adviser and arranging for them to make repair or provide reports on the extent of the damage, loss or injury;
read and understand loss adjusters, lawyers and expert opinion reports. These should not be accepted blindly but read to ensure they are complete and their conclusions are logical.
monitoring the progress of a claim;
investigating potentially fraudulent claims;
identifying reasons why full payment may not be made;
minimise claims leakage, that is the over payment of claims or consultant fees or the payment of a non-valid claim;
ensuring fair settlement of a valid claim by the insured;
negotiating a prompt and commercially sound settlement with third party claimants;
building relationships with loss adjusters, forensic accountants and solicitors, as well as other legal/claims and consulting professionals;
ensuring the customer is treated fairly and that the customer receives excellent service in accordance with industry and company guidelines;
involvement in loss adjusting and legal discussions relating to settlement;
seeking legal recovery of monies paid out;
managing a team of claims handlers (at managerial level);
taking responsibility for productivity and profit;
adhering to legal requirements, industry regulations and customer quality standards set by the company.