Elements and Performance Criteria
- Receive notification of claim
- Receive claim
- Record/register claim
- Estimate a claims reserve, including reinsurance as appropriate
- A preliminary reserve/estimate is calculated, where appropriate, according to organisation reserving policy
- For a routine claim, a determination may be made on acceptance or referral of claim in accordance with organisation policy and procedures
- Need for internal or external service providers is identified, if appropriate
- Policy is checked for reinsurance details, if applicable
- Reinsurers are advised of potential claim, if applicable, by raising reinsurance advice
- Potential impact of the claim on the premium is reported as required
- Create claim files or add information to existing files
- Correspondence is filed in correct claims files and allocated to relevant claims operatives
- All missing information, abnormalities or classification uncertainties are referred according to organisation policy
- An appropriate date is entered into diary system, where necessary
- All information is completed accurately and clearly, and in accordance with legislative and organisation requirements
- Completed documentation is filed or referred for processing if appropriate