Providing Excellent Customer Service: The Fundamentals of Claims Handling

TABLE OF CONTENTS

PART 1: THE ROLE OF THE CLAIMS DEPARTMENT	1
THE FUNCTION OF THE CLAIMS DEPARTMENT: BALANCING GOALS	2
ENSURING THE INSURED’S POLICY IS UPHELD	3
SUPPORTING THE INSURANCE COMPANY’S BUSINESS REPORT GOALS	6
THE STRUCTURE OF THE CLAIMS DEPARTMENT: PERSONNEL THAT PROMOTE SUCCESS	8
CLAIMS ADJUSTER VS CLAIMS HANDLER: WHAT IS THE DIFFERENCE?	9
SECTION REVIEW	12
PART 2: THE CLAIMS HANDLING PROCESS– A CLOSER LOOK	13
BASICS OF CLAIMS HANDLING: WHAT IS A CLAIM?	14
BASICS OF CLAIMS HANDLING: THE PROCESS	15
RECEIVING, ACKNOWLEDGING AND ASSIGNING THE CLAIM	16
IDENTIFYING THE POLICY	18
COMMUNICATION WITH THE POLICY OR THE POLICYHOLDER’S REPRESENTATIVE	28
INVESTIGATING THE CLAIM	31
DOCUMENTING THE CLAIM	34
DETERMINING THE CAUSE OF LOSS AND OTHER IMPORTANT INFORMATION	35
CONCLUDING THE CLAIM	40
SECTION REVIEW	41
PART 3: FACING CHALLENGES, CREATING SOLUTIONS	42
THE UNEXPECTED CONSEQUENCES OF THE COVID-19 GLOBAL PANDEMIC	43
FACING A POST COVID-19 WORLD: CHALLENGES	44
CHALLENGE 1: THE DEFINITION OF POST-COVID-19 CONDITION	45
CHALLENGE 2: INSURANCE FRAUD	46
CHALLENGE 3: REGULATORY COMPLIANCE	47
CHALLENGE 4: THE EXPENSE OF CLAIMS DENIALS	49
FACING A POST COVID-19 WORLD: SOLUTIONS	50
SOLUTION 1: UTILIZING EFFECTIVE CLAIMS MANAGEMENT TOOLS	51
SOLUTION 2: INCORPORATING DIGITAL CLAIMS HANDLING TECHNOLOGIES	52
SOLUTION 3: IMPROVING INTERPERSONAL COMMUNICATION SKILLS	58
SECTION REVIEW	63
COURSE REVIEW	64
PART 1: THE ROLE OF THE CLAIMS DEPARTMENT	64
PART 2: THE CLAIMS HANDLING PROCESS– A CLOSER LOOK	66
PART 3: FACING CHALLENGING, CREATING SOLUTIONS	68
REFERENCES	70