Profession 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.

Personality Type

• Conventional / Enterprising
• Conventional / Realistic
• Enterprising / Conventional

Knowledge

• 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.

• Claims procedures

  The different procedures that are used to formally request a payment for a suffered loss from an insurance company.

• Principles of insurance

  Understand the principles of insurance, including third party liability, stock and facilities.

• 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.

• Actuarial science

  The rules of applying mathematical and statistical techniques to determine potential or existing risks in various industries, such as finance or insurance.

Skills

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• Provide financial product information

  Give the customer or client information about financial products, the financial market, insurances, loans or other types of financial data.

• 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.

• 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.

• 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.

• Apply technical communication skills

  Explain technical details to non-technical customers, stakeholders, or any other interested parties in a clear and concise manner.

• 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.

• 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.

Optional knowledge and skills

Source: Sisyphus ODB