Insurance Claims Handling

Handle assessment and investigation of insurance claims to ensure efficiency and effectiveness of claims functions and reduce risk exposure



Competency Area

Investment and Financial Management


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