How Do Insurers Handle Claims?

What is a claim?

• A request by a person or business seeking compensation from an insurer for a loss that may be covered by an insurance policy.

• A document used to apply for a new insurance policy.

• A type of insurance policy for businesses only.

• A payment made by an insurer to purchase a new policy.

Fill in the blank: A claimant is the party who makes the claim. Who is a claimant?

• The party who makes the claim.

• The party who investigates the claim.

• The party who denies the claim.

• The party who witnesses the claim.

Who is a claims representative?

• The person responsible for investigating, evaluating, and settling claims.

• A person who sells insurance policies to customers.

• An individual who manages investment portfolios.

• A person responsible for underwriting insurance applications.

What does a claims manager do?

• Directs and supervises some activities, such as setting goals for closing claims, developing the professional skills of staff, and establishing claims procedures for the department.

• Handles only customer complaints without any administrative duties.

• Performs only data entry tasks related to claims processing.

• Manages the company’s marketing and advertising campaigns.

What do claims supervisors do?

• Assist claims managers by reviewing claim files to make sure they're being handled correctly and consistently and help determine strategies around business and staff development.

• Process insurance applications and issue new policies to customers.

• Develop marketing campaigns to attract new clients for the company.

• Handle only customer complaints and escalate all issues to upper management.

Which of the following is NOT a type of claims representative?

• Telephone claims representative

• Field claims representative

• Specialized claims representative

• Underwriting claims representative

Claims professionals collaborate with each other and other departments to meet insurers’ goals by:

• Sharing information and coordinating efforts

• Working independently without communication

• Focusing only on their own tasks

• Avoiding interaction with other departments

According to the passage, why is interdepartmental cooperation important in an insurance organization?

• It allows departments to work independently

• It is integral to an efficient claims department

• It reduces the need for collaboration

• It increases competition between departments

Which department needs claims experience information to direct resources and efforts to crucial areas of an insured’s operation?

• Marketing Department

• Risk Control Department

• Premium Auditing

• Underwriting

Fill in the blank: The Claims Department relies on ________ for data that can support the loss adjusting process.

• risk control

• marketing

• human resources

• customer service