Overall job content
The overall role of The European Certified Insurance Claims Manager SQF 6 is to handle claims information and documentation to as-sess the validity of a claim and to decide whether to accept and approve, in full or in part, or decline a claim in accordance with
- The terms and conditions of the policy
- The guidelines and practices of the company
- The codes of good practice of the industry
- The laws and regulations of the country
In addition the Claims Manager is responsible for:
- Managing specialist knowledge on claims handling and the given insurance class
- Identifying trends in the claims development and the market structure
- Developing new products
- Translating new legislation into processes, procedures and practices
The profile covers any class of insurance, including reinsurance business and it is intended for a Level 6 Claims manger dealing with all classes of business within the European insurance market and who may be representing both a local or foreign firm. The claims mana-ger deals with the most complex:
The certificate holder does not have to have training within all insurance classes, but can be certified based on any class.Exams applying for accreditation of European Certified Insurance Claims Manager must meet the following criterias within knowledge, skills and competences.
The details of the country’s legal principles, regulations, directives and code of ethics which affects claims business.
Receive incoming complex claims notifications, generate corresponding claims records and take first action
Ensure that the claims handling process is handled in a professional and ethical way.
In detail, the company’s policy cover, terms and conditions, including extensions and/or limitations.
Investigate and evaluate complex claims
Handle claims economically, efficiently, promptly and fairly.
The policy cover, terms and conditions of the company’s main competitors.
Approve the claim, fully or partly
Apply specialized knowledge to determine validity of the claim.
The specifics of methods of claims assessment and investigation, in theory and in practice.
Reject the claim, fully or partly
Involve relevant (internal and external) parties in the claims settlement process and negotiate the solution
The specific insurance challenges related to the given insurance line
Evaluate the customers current and past claims and decide whether to change or terminate the customer’s policy and coverage
Supervise and spar with employees and other departments during the claims handling process and approve final settlement
In detail, methods and prescriptions of loss mitigation, recovery and salvage.
Communicate effectively in order to;
Analyse the claim in order to apply policy provisions, limits and excesses / franchises depending on proximate cause of the claim, indemnity requested, liability and/or negligence if applicable.
Methods for applying reserving, subrogation, and contribution.
Set, monitor and maintain company guidelines and processes
Ensure that claims are settled in a way that benefit both the customer and the company, through
In detail, the organization’s policies and procedures for processing claims and payment of claims
Ensure compliance and upkeep with market developments
Ensure and manage an effective collaboration and communication with relevant units such as legal, underwriting, sales and marketing,
In detail, the organization’s customer service standards and procedures, including those for dealing with complaints.
Monitor claims performance and take corresponding decisions
Build and maintain a profitable customer relationship
The roles & responsibilities of various parties (agents, broker, etc) involved in or influencing the claims handling process
Manage key information related to claims handling
Continuously improve the claims handling processes and guidelines
The roles and functions of other parties engaged in claims activities (experts, suppliers, repairers, surveyors, loss adjusters, etc.), including those used by the organization to settle claims
Co-operate/liaise with legal representatives on legal matters
Ensure that the organizations (inside and outside ‘Claims’) are updated on claims handling products, tools and processes
Methods of identifying suspected fraud in a claim and the action required.
|Leakage and its effects on insurers|