Claims Examiner, SPL

1.    Processing new claims in accordance to the latest Claims Best Practice or SOP document(s), with guidance of updated Letter of Authority granted.

a)    Issue acknowledgement note to Insured/intermediaries/marketers.
b)    Appointment of adjusters if necessary.
c)    Ensure prompt and accurate claim registration within 5 working days.
i.    Ensure Claims file creation (i.e. in Workview)
ii.    Reserves created in the Financial Systems ( PolisyAsia & Meridian)
iii.    Ensure all correspondences & docs being filed (i.e. in Workview)
d)    Follow-up for initial report from adjuster/surveyor/expert.
e)    CABFAC/CABCO Claims recoveries on outward placement 
•    Ensure PLA, RLA and SLAs sent to all follow insurers i.e. CAB & NONCAB within 7 working days.  
f)    Timely issuance of PLAs, RLAs and SLAs to treaty reinsurers (where necessary)

2.    Monitoring the progress of claims
a)    Follow up with adjuster/surveyor/expert for the status of the claims including timely update the provision of reserve.
b)    Follow-up with adjusters for their Preliminary Report/Status Report/Final Report.
c)    Issue reminder to Insured/intermediaries/marketers on outstanding docs/information required.
d)    Diary/Pend the outstanding files for monitoring purposes.

3.    Claim processing

a)    Fast Track Claims (internal handling) – immediate attendance to  claims to reach claim settlement within 3-5 working days. 
b)    Non-Fast Track Claims (external handling) - claim approval within 7 working days upon receipt of adjuster’s reports / last info or docs required.
c)    Ensuring fair and expeditious settlement of a valid claim in accordance to policy conditions, statutory requirement and Claims Best Practice.
d)    Communicate claims decision (offer or denial) to Insured / intermediaries/ marketers.
e)    Accurate claims payment including maintaining record of banking details & other related documents as required. 
f)    Ensure all correspondences & docs being filed (i.e. in Workview)
g)    Ensure consistency in file status at Workview and PolisyAsia & Meridian

4.    Handling of complaints i.e.
a)    To monitor and manage complaints and disputes.
b)    To evaluate complaints so as to reduce the occurrence of systematic and recurring problems of service-related issues.

5.    Attending internal and external phone calls on claims related enquiry from claimants, Business Units & intermediaries.

6.    Timely submission of periodic and ad hoc requests for data, analysis and reporting i.e. large loss report to management, monthly XOL report, PIAM Quarterly report etc.

7.    Conduct file review – minimum once a year.

8.    Others 
a)    Vendor management – compliance of service standard 
b)    Fraud Management – fraud identification & management
c)    Subrogation Recovery – early action to be taken.