Elements and Performance Criteria
- Analyse claim to determine validity
- Validity of claim is assessed against organisation and policy acceptance criteria for relevant type and category of policy
- Information is confirmed as accurate, comprehensive and authentic
- Inclusive validity is sought from specialists for advice where required
- Reinsurer is notified of any claim immediately
- Evaluate the impact of a claim
- Data relating to the extent of the loss, damage or injury situation is analysed and claim estimates sought and reviewed
- Claim is compared to expected payment projections for the product type, and business impact is determined
- Strategies to minimise negative impact of any non-routine/complex claim are determined within requirements to meet policy obligations
- Necessity for urgent action to protect organisation interests is determined
- Determine settlement options
- Manage support arrangements to resolve the claim
- Liaise with relevant parties to identify and meet support requirements such as partnering with external experts to ensure clients' needs are met
- Manage any legal processes from a non-routine/complex claims perspective, including international legal system requirements, if applicable
- Employ mediation skills to resolve issues or disputes associated with a significant claim, as required
- Identify any required changes to policy or procedures
- Report findings and update records
- Actions, procedures and outcomes are documented and recorded promptly and accurately
- Stakeholders are provided with accurate and timely advice regarding claim proceedings
- Finalised claims files are stored and maintained according to organisation policy and legislative requirements and codes of practice, as applicable