Insurance Claim Management
The last stage of an insurance contract is claims. The main formula of an insurance contract is, “You pay the premium and if any mishap happens then I will give you compensation in the form of claim.” Hence claim is the soul of insurance business. The promise to give compensation means claim. The insurance business prospers on the basis of claim. The policy holder has the faith that if any adverse thing happens then he and his family members will get the claim. Due to this faith the policy holders pay the insurance premium regularly. The insurance claim is the most delicate and sensitive issue of insurance business. The claim processing is a very complicated procedure which is to be carried out with great responsibility. The entire process of insurance claim is very interesting.
The claim process includes following steps:
1) Providing claim notices
2) Provide claim form
3) Listing of required important documents
4) Presenting the claim form along with the related document in specific time
5) Spot survey and final survey
6) Claim investigation
7) Checking of the nomination
8) Filling the claims form
9) To check the legal claim aspects
10) Claim payment
Whenever a claim is made, the insurance office has to give the notice of that claim. The insurance company at the same time also provides the claim form and the list of required important documents to the policy holder or the nominee in case of death of the policy holder. The policy holder or the nominee has to submit the required documents and the duly filled claim form to the insurance office within a specific time. After this the claim department does the sorting of all the documents. Investigations are done by the claim department to find out whether the claim is worth payable or not. If required independent professionals are hired to do the investigation and for this the help of Surveyors and loss assessors is taken. Along with this all the legal aspects and legitimacy of nominee are investigated with the help of a lawyer. After the verification of all the doubts and after feeling completely sure about the doubt, the claim payment is made.
The whole procedure of insurance claims requires claim managers on a large scale. The insurance claim management has various posts from assistant to general manager. The claim procedure is different for different types of insurance policies. For example, life insurance includes following type of claim procedure:
1) Death claim – paid on the death of the policy holder
2) Maturity claim- paid on the maturity of an insurance policy
3) Survival benefit claim- paid after specific time period in money back policies
4) Physical disability claim: Paid if the policy holder suffers from physical disability during the policy term.
5) Critical illness rider claim: Paid if the policy holder suffers from critical disease during the policy term.
In the processing of all the above types of claim, the policy holder or the nominee has to submit the original policy document along with the related documents to the insurance company. While processing the claim of health insurance policy, the policy holder has to submit all the original bills of the hospital and the original policy document. While processing the claim of general insurance policy spot survey and final survey are made and many other proofs are required depending upon the situation.
Claim Procedure
Claim processing is a very challenging job. It is said oddly that the main objective of claim processing is to reject maximum claim proposal. The policy holders have to face very odd experience during the claim processing. The reason behind this is the lack of knowledge regarding claim processing. Due to this thousand of claim companies, customer forums and Supreme Court are struck in the claim cases. Many times the claim managers behave very strangely while carrying out the claim processing. They have to look after the benefit of the insurance company as well as the policy holder at the same time. If the policy holder or nominee submits any wrong documents then it is taken responsible for rejection of claim. Inquisitiveness, minute observation, common sense, analyzing capacity, listening ability and high quality of patience are required while working in the claims department. Along with this the overall knowledge of insurance and claim processing is also required. For this one has to complete the training of insurance claim management.
The claim department requires employees for carrying out various functions right from claim intimation registration to claim payment. The insurance companies are having the challenge to settle maximum claim in lesser time. The insurance companies have to submit the quarterly report of pending claims and paid claims. The company which pays the claim easily and quickly gets more publicity. But this does not mean that every company which pays the claim quickly is trustworthy. Many times bogus claims are settled. If the insurance company settles each and every claim then it will become bankrupt.
Today almost a decade has elapsed for the privatization of the insurance sector. The number of claims is also increasing. Every insurance company is taking proper care while claim processing. The IRDA has indicated that the insurance company should try to avoid the settlement of fake claims as well as try to settle the eligible claim in specific time period. To follow this indication, the claim department requires man power on large scale. Since the insurance business has now become customer oriented, there is an increasing demand for claim settlement and claim management and for this smooth claim management has become an important aspect.
Along with insurance companies, the claim managers also have a wide scope in banks, claim service providers and in insurance broker offices. The claim managers can also work as independent claim consultant. The increased propagation of insurance business has resulted in the increase in number of claims. In such case, before approaching the insurance company, the policy holder can consult with the claim consultant. The retired persons of insurance company can also work as claim consultant after completing the course of claim management.
Those who are not interested in the sales and marketing area of insurance and want to work in the administrative field of insurance also have a wide scope in claim management. The women also have good opportunities in the field of claim managements since the job profile is completely that of office work. Claim management is the perfect field for insurance personnel’s to progress further. At the end, education, experience and finding new opportunity is the indication of success.
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