Insurance Claims Handling
Handle assessment and investigation of insurance claims to ensure efficiency and effectiveness of claims functions and reduce risk exposure
Type
Domain
Competency Area
Investment and Financial Management
Levels
Process claims and monitor accounts receivables
Check calculations of expenses for completeness and inclusion of required supporting evidence
Determine that claims amounts are correct, and are in line with the amounts payable
Conduct investigation to determine acceptance or rejection of claims
Process valid claims for expenses within agreed timelines
Maintain accurate and up-to-date records of claims made
Ascertain outstanding receivables due
Monitor transactions to ensure timely collection of receivables
Verify records of outstanding receivables due
Identify common indicator of fraud and incorporate these into claims decisions
Develop procedures for claims processing and investigate payment discrepancies
Develop the organisation’s standard operating procedures for collecting claims and payments
Monitor and evaluate payment handling systems
Cascade information to team members in operating payment handling systems and procedures
Monitor feedback from staff and customers regarding systems and procedures
Identify new methods and systems for dealing with payments
Monitor payments and ensure data is updated timely and accurately
Investigate payment discrepancies
Perform analysis to detect and investigate potential fraudulent activities against common indicators of fraud
Drive claims function strategies and ensure effectiveness of claims processing
Endorse organisation’s standard operating procedures for collecting claims and payments
Evaluate impact of changes to claims handling to the organisation
Formulate claims handling strategies to maintain high standards
Evaluate effectiveness of claims function and claims handling approaches
Ensure claims function effectiveness
Advice on fraud investigation methods for fraudulent activities