Elements and Performance Criteria
- Collect and organise information relating to claim
- All relevant information is obtained to determine whether a valid claim exists (liability)
- Relevant information is organised into a coherent and valid body of case knowledge
- Confidentiality of information is maintained according to legislative requirements and industry principles as appropriate
- Any information deficiencies are identified, and additional information is sought from appropriate sources
- Research claim and validate claim information
- Claims information is checked to determine legitimacy of claim, including validity of the policy, and whether the claimant is eligible to claim on the policy
- Needs for investigation/further information are identified and appropriate service provider/s are appointed where necessary
- Information is provided to reinsurers, if applicable
- Investigation and research are undertaken within established claims management criteria and authorities
- Progress of investigation is monitored, if applicable
- All missing information, abnormalities or classification uncertainties are referred to an appropriate authority
- Maintain records and lines of communication
- Regular contact is maintained with the relevant parties to ensure that they are aware of the current status of the claim and are actively participating in the process
- Information which impacts on the policy is communicated promptly to the underwriter
- Diary system is maintained regularly and accurately and timelines adhered to