Duties and Responsibilities
Ensures that general insurance claims are handled expeditiously and in a professional manner thereby meeting the customer expectations. Manages the claims function with a team of claims assessors and negotiators. Develops the claims policy, procedures, and practices. Evaluates risks with claims, coverage complexity, and those in excess of field approval limits. Provides counsel regarding claims evaluation and coverage.
Responsibilities
Insurance Claims Evaluation
Investigate the circumstances of complex, high-value claims and the nature and extent of clients' losses. Review and evaluate information gathered using own expertise, and examine additional evidence provided by specialist investigators or subject-matter experts to determine the extent of liability. Negotiate settlement of insured losses in line with delegated authority.
Insurance Claims Administration
Review and analyze very complex, high-value insurance claims in line with the organization's claims policies, procedures, and customer service standards. Initiate specialist investigations and engage loss adjusters and/or subject-matter experts where appropriate. Authorize claims within delegated authority and refer complex or unresolved issues to line manager.
Fraud/Financial Crime Management
Develop and deliver specialized fraud prevention and monitoring activities for an area of operations, in line with the organization's fraud management policies and procedures, to enable the prevention of fraud and enable the initiation of loss mitigations and fraud investigations.
Fraud/Financial Crime Investigation
Investigate cases of suspected fraud or financial crime. Identify lines of inquiry, and gather and retain information and physical or electronic evidence to support criminal investigation and/or legal action, engaging specialist investigators or subject-matter experts where necessary. Review the evidence gathered and recommend appropriate action to the organization.
Fraud/Financial Crime-Management Systems Development
Research and identify fraud trends and emerging risks, contribute to the drafting of fraud prevention policies and procedures, and identify opportunities for new and/or improved anti-fraud systems functionalities to support the development of fraud/financial crime prevention strategies, policies, procedures, and monitoring systems.
Leadership and Direction
Communicate the local action plan; explain how this relates to the function's strategy and action plan and to the broader organization's mission and vision; motivate people to achieve local business goals.
Work Scheduling and Allocation
Develop short- or medium-term work schedules in order to achieve planned commitments. Approve overtime or use additional resources as needed.
Financial Policies, Guidelines, and Protocols
Develop and deliver financial guidelines and protocols to ensure the company complies with regulations and good financial practice.
Performance Management
Develop and propose own performance objectives; take appropriate actions to ensure achievement of agreed objectives, using the organization's performance management systems to improve personal performance. Or manage and report on team performance; set appropriate performance objectives for direct reports or project/account team members and hold people accountable for achieving them, taking appropriate corrective action where necessary to ensure the achievement of team/personal objectives.
Solutions Analysis
Analyze specific problems and issues to find the best solutions. Solutions could be technical or professional in nature.
Regulatory and Compliance Management:
Investigate all kinds of incidents and reports and provide expert advice to more senior colleagues. Minimize risk exposures and ensure adherence with regulatory standards by working with all internal functions to make sure compliance programs are properly implemented.
Organizational Capability Building;
Use the organization's formal development framework to identify the team's individual development needs. Plan and implement actions to build their capabilities. Provide training or coaching to others throughout the organization in own area of expertise to enable others to improve performance and fulfill personal potential.
