Overall job content
The overall role of The European Certified Insurance Claims Handler SQF 4 is to receive, investigate, evaluate and register claims in-formation and documentation to assess the validity of a claim and to decide whether to accept and approve, in full or in part, or decline a claim, restricted to standard claims, from standard retail products, possibly under supervision and 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
The profile covers any class of insurance but is restricted to standard retail products and simple claims dealing with all classes of business within the European insurance market and who may be representing both a local or foreign firm
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 Handler must meet the following criterias within knowledge, skills and competences.
The country’s legal principles, regulations, directives and code of ethics which may have effect on claims business.
Receive incoming notification of standard claims, generate corresponding records and take first action according to company guidelines
Act in a professional and ethical way.
The policy cover, terms and conditions relevant to your work including standard extensions and/or limitations.
Investigate and Evaluate claims, assisted by company system and guidelines
Work organized and systematically in order to record details of claims accurately; identify and request missing information and/or documentation.
General methods of standard claims assessment and investigation, and the resources his/her organization has to conduct these activities.
Determine whether to approve in full or in part or decline, liability and/or pay-ment of claims within authorized limits and within a supervisor authorization
Handle claims economically, efficiently, promptly and fairly.
Basic methods and prescriptions of loss mitigation, recovery and salvage.
Approve the claim, fully or in part
Guide peers on how to apply company systems, rules and guidelines when handling standard policies
The organization’s policies and procedures for processing claims and payment of claims, and the authorized limits for your position
Reject the claim, fully or in part
Establish cause-and-effect relation 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.
General principles for reserving and contribution principles
Communicate effectively with the customer in order to;
Think responsibly in order to
The organization’s customer service standards and procedures, including those for dealing with complaints.
Maintain a confident relationship with the customer during the claims handling process
Roles & responsibilities of various parties (agents, broker, etc) involved in or influencing the claims handling process
Use induction in order to identify claims which are valid or not valid through combining pieces of information and documentation.
The roles and functions of other parties engaged in claims activities (repairers, surveyors, loss adjusters, doctors,etc.)
Authorized experts, suppliers and/or repairers used by your organization to settle claims
Company guidelines for how to handle suspicions of fraud
Understanding of leakage and its effects on insurers