By Dumisani Dlamini
Head of Claims – KlaptonRe
The claims management function refers to the end-to-end process of handling, assessing, and resolving claims submitted by policyholders or third parties under an insurance policy and or a reinsurance contract. It involves strategically managing all aspects of the claims lifecycle from initial notification to final settlement or denial thereof with the aim of ensuring empathy, efficiency, fairness, compliance, and cost control. Below are some of the main important roles in my opinion which are played by the Claims Department in an organisation.
The Role Of The Claims Function
The role of the claims function is to manage and process insurance claims or requests for benefits under an insurance policy or contract. It is a critical component in the operation of insurance companies and other risk-management entities.
Key functions of the claims process are prompt settlement of valid claims, preventing fraud, economic restoration to name but a few. Claims handling is an art, which is perfected over a reasonable period of time.
In summary, the claims function is where the promise of insurance becomes real, and this is the point where the Claims Department is referred to as the “window to the public”. The public pay premiums for insurance protection with the view to having their claims settled at the time of a loss of that particular subject of insurance.
Back-Office Function
The Claims Function is no longer considered as a back-office function anymore. Claim handlers also help promote the company by ensuring that all valid claims are handled in a manner that will seek to increase the business fortunes of the particular (re)insurer. Claims are, most of the time, at the center of discussions between the insuring parties, which therefore echoes the point that they also form part of the marketing wing of the organization. Without the Claims Department’s input, the renewal process in insurance, where the premium rates and warranties to be imposed onto the policy for the renewal period are discussed, wouldn’t be successfully negotiated.
Customer Service
It is a critical function that directly affects an insurer’s reputation, and retention or expansion of the business. From a claims perspective, it involves supporting and guiding customers throughout the claims process with clear communication, empathy, efficiency, and fairness.
- Communication – The Claims Department is required to effectively communicate the position of the claim to the stakeholder. Request any outstanding documentation immediately and avoid a situation where the client waits for long periods before the request for further document to be provided.
- Empathy – Always have the client’s interest at heart when processing the claim.
- Efficiency – Always look for reasons to pay a claim rather than looking reasons to decline. Looking for reasons to decline or reject a claim always causes problems because it might lead you not to analyse the claim and the policy wording accurately. Attention to detail is key in such instances.
Processing Of Claims
One needs to be open-minded with no preconceived ideas about a claim. As I mentioned before, a prudent claims handler always looks for the reasons to pay the claim.
In conclusion, the Claims Management function in an insurance organisation is significant and I’m proud to be a part of this great institution called Claims.