WHAT DOES A CLAIMS HANDLER DO?
The Claims Handler serves as the primary contact for policyholders, offering guidance throughout the claims process and ensuring exceptional service by collecting accurate information for claim advancement. This position's responsibilities include evaluating claims to determine accurate coverage, managing a caseload of Structural Warranty claims, and coordinating with the Recoveries Team to identify potential recoveries. Additionally, this role involves setting reserves, handling claim declinations and appeals, supporting departmental colleagues, improving processes, preparing litigation cases, identifying trends, and managing additional tasks as needed to meet departmental targets.
A Review of Professional Skills and Functions for Claims Handler
1. Claims Handler Duties
- Insurance Understanding: Understanding of insurance and policy wording is essential when determining if the insured party is covered when assessing a claim.
- Claim Detail Recording: Taking detailed particulars of each claim from the client/insured party as to the circumstances of the claim.
- Incident and Valuation Knowledge: Knowledge of determining the nature of the incident, ascertaining medical details to obtain Veterinary Certificates and also a strong understanding of animal/livestock valuations.
- Evidence Requesting: Requesting photographic evidence.
- Insurer Liaising: Liaising with Insurers to notify them of the claim and supplying external bodies with all relevant documentary evidence.
- Claim Reporting: Reporting and keeping the insured client informed of the claims progress.
- Case Reviewing: Responsible for reviewing cases in line with established standards, procedures, and guidance provided.
- Complex Case Identification: Identifying complex cases and escalating them to more qualified colleagues to ensure they are handled appropriately.
- Customer Interaction Management: Managing customer interactions in an efficient, courteous, and timely manner to deliver high standards of customer satisfaction.
- Supplier Organizing: Organizing and using approved internal/ external suppliers to ensure utmost customer satisfaction.
- Colleague Support: Providing support to more experienced colleagues.
- Policy Contribution: Contributing to the production of new policy wordings or reviews of existing policy wordings to ensure current and accurate documentation.
2. Claims Handler Details
- Claims Advice: Act as the main point of contact for Policyholders, providing advice on the claims process and excellent customer service.
- Information Collection: Collect accurate information and documents to proceed with a claim, ensuring all information is accurately recorded and maintained on the claim file.
- Claims Assessment: Assess a claim made by a policyholder fairly and consistently to ensure correct coverage decisions are made.
- Caseload Management: Proactively manage own caseload of Structural Warranty claims, of medium to large value and complexity, ensuring they are correctly handled and there is a fair and prompt settlement of any valid claims.
- Recovery Coordination: Work with the Recoveries Team to highlight potential recovery and/or mitigation opportunities.
- Reserve Management: Set and maintain appropriate reserves throughout the lifecycle of all claims.
- Claims Handling: Handle claims declinatures and appeals.
- Team Support: Provide support and guidance to other members of the Claims Department.
- Process Improvement: Regularly review and improve existing processes.
- Litigation Preparation: Prepare cases for Litigation.
- Trend Analysis: Identify and escalate trends or concerns.
- Alternative Work Management: Conduct additional/alternative work by team leader to cover absenteeism or facilitate the smooth running of the department to achieve targets.
3. Claims Handler Responsibilities
- Claims Oversight: Oversight of claims from the start to settlement, working independently with responsibility for the proactive management of the claims caseload.
- Claims Reporting & Coordination: Reporting on claims and coordinating with internal colleagues and external providers to ensure instructions are given and payments are made in a timely manner.
- External Liaison: Liaising with the Trust’s external loss adjuster, insurance specialists, and external legal advisors.
- Claims Administration Management: Manage all administration aspects of claims made against the Trust.
- Data Input Management: Data input, ensuring all information is captured and inputted onto internal systems.
- Claims Tracker Implementation: Implementing and managing an internal claims tracker/workflow for live claims.
- Customer Contact: Receive telephone calls from drivers or fleet contacts regarding damage to vehicles as a result of a road traffic accident or damage.
- Claims Assessment: Ask appropriate questions and assess the best course of action with customer service and cost management in mind.
- Ongoing Claims Management: Manage all ongoing tasks for claims and be the point of contact for all external or internal contacts.
- Claims Progress Management: Liaise with customer contacts, repairers, and insurance companies to progress claim keeping all parties informed of progress.
- Documentation Management: Manage all aspects of onward documentation.
4. Claims Handler Job Summary
- Customer Service: Provide a high level of customer service at all times
- Claim Investigation: Investigate all claims within an allocation, reaching a decision as to initial liability and continued validity
- Communication: Communicate all claims decisions in a timely and appropriate manner
- Rehabilitation Collaboration: Work with the Customer Care rehabilitation team in promoting and assisting claimants in returning to work
- Relationship Management: Build and maintain strong relationships with all customers, cooperating with Sales in developing and maintaining business
- Proactive Claims Handling: Demonstrates proactive claims handling via use of telephone to progress claims rapidly
- Settlement Negotiation: Negotiates settlements by telephone
- Litigation Preparation: Prepares cases for defence in litigation
- Compliance and Quality Control: Ensure data provided is compliant and quality controlled
- Vehicle Downtime Management: Manage all aspects of vehicle down time
5. Claims Handler Accountabilities
- Portfolio Management: Drive a portfolio of injury claims to settlement within acceptable cost parameters.
- Reserve Accuracy: Keep case reserves accurate and up-to-date.
- Settlement Negotiation: Negotiate settlements by telephone.
- Rehabilitation Coordination: Discuss the Rehabilitation Programme with the claimant’s solicitors by telephone.
- Litigation Preparation: Ensure all evidence is obtained early so that we are litigation-ready.
- Fraud Detection: Identify suspicious claims.
- Liability Decision: Ensure liability is decided early and appropriate cases are retained in the portal.
- Service Level Compliance: Ensure workload remains within Service Level Agreements.
- Stakeholder Communication: Update Corporate Clients, Agents, and Brokers on the progress of claims.
- Role Model Leadership: Act as a role model to the team both for behaviors and in the quality of work and results.