Insurance Claims Handling (IF4)

What is your claim Philosophy?

Claims Philosophies:

An Anonymous once said, “fixable underwriting philosophy means rigid claims philosophy and vice versa”, that might be true to some extent when the underwriting process and the claims handling process are handled in the same department, but when both are handled in two different department - which is the case in the majority of the insurance companies - the true identity of the claims handler will be expressed clearly from the moment of the claim notification till the moment of claim settlement.

How the claims personnel will handle the claim, is very crucial in the customer retention process later on, and retaining customers is vital for the sustainability of business because retaining one client for one renewal at least is 80% cheaper than getting the new client with the same business size.

The client’s experience:

It is not true that the client will always move from one insurance company to another because of a rejected claim, the truth is that client will definitely move from one insurance company to another because of the improper claim handling regardless the claim was paid or rejected.

During the underwriting process, everybody is happy and things are going smoothly, but when there is a claim on the stake there are no disguises here and things are crystal clear, the claim is the real testing for the competency of the insurance company’s claims personnel. 

How the claims personnel will handle the claim will always be the core of the relationship between the client and the insurance company and the client’s word of mouth about his experience with the company’s claims personnel will be based on a real tangible experience and it will be more appealing to the community either over the social media or any other mean of communication.

The claim might be paid fully or partially or may be rejected, how the claim is handled, how the technical information is passed to the client, how the survey is conducted is what really matters and counts from the client’s perspective and is more important than the final decision.

How the claims personnel handle the claim?

Some claims personnel will handle the claim in a very firm and rigid manner and their main aim is to find a warranty or exclusion or a breach to any policy condition that can be the to avoid the claim payment, others might do the contrary and try to help the client in getting his claim paid according to the fair interpretation of the policy terms.

Why Claims Personnel does this?

It is strongly believed the main reason behind adapting one of these two approaches is the claims handler’s experience and level of awareness, the more awareness means the more professionalism.

When the level of awareness is high, the vision will be clearer and the negotiations will be based on solid ground, moreover when the level of knowledge and awareness are high the claims personnel will be able to detect fraud easier, example the claims personnel can detect the fraud from the very thorough and comprehensive claim file, because sometimes the very comprehensive file is too good to be true.

Increasing the level of awareness:

The level of awareness can be increased either by gaining more experience or by studying, but it is noteworthy to mention that experience only without being supported by studying is very expensive to the employer and on the other hand, studying only is useless because there is no experience gained from the real arena.

The optimum solution is to gain knowledge whilst working and studying simultaneously, this can be only achieved by enrolling with reputable insurance institutes such as the CII.

As a starter with the claims career, it is strongly recommended to start the education path by studying Insurance Claims Handling Process (IF4) from the CII and attend its clauses in Riyadh.

The IF4 Exam:

The exam is 75 multiple choice questions that should be answered in 2 hours.