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What does a Claims Handler do?

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What does a Claims Handler do?

​A day in the life of an Claims Handler can vary depending on the specific company and type of insurance they work with. However, here's a general overview of what a typical day might look like for an Claims Handler:

  1. Reviewing and Organising Claims: The day often begins by reviewing the claims received overnight or during the previous day. The Claims Handler will go through each claim, verify the policy details, and organise them based on priority and severity.

  2. Gathering Information: Claims Handlers need to gather all the necessary information related to a claim. This involves contacting the policyholder, speaking with witnesses if applicable, and collecting any relevant documents such as accident reports, medical records, or repair estimates. They may also liaise with other departments, such as underwriting or legal, to gather additional information.

  3. Assessing Coverage: Claims handlers need to analyse the policy coverage and determine if the claim falls within the terms and conditions outlined in the insurance policy. They evaluate the circumstances of the incident and compare it against the policy provisions to establish coverage eligibility.

  4. Investigating Claims: For complex or high-value claims, additional investigation may be required. Claims Handlers may work with specialised investigators to gather more information, such as interviewing involved parties or inspecting the damaged property. They assess the validity of the claim and determine if any fraudulent activity is suspected.

  5. Communicating with Stakeholders: Effective communication is crucial for claims handlers. They regularly interact with policyholders, explaining the claims process, answering questions, and providing updates on the status of the claim. They also collaborate with various parties such as medical professionals, repair shops, and legal representatives to ensure a smooth resolution.

  6. Evaluating Damages: Claims Handlers assess the extent of damages or injuries and determine the appropriate compensation based on the policy terms and relevant laws. They may consult experts or use internal tools to estimate the value of losses accurately.

  7. Decision Making: Once all the necessary information is gathered, Claims Handlers make decisions regarding claim settlements or denials. They consider policy provisions, applicable laws and regulations, and company guidelines to arrive at fair and consistent outcomes. If needed, they negotiate with policyholders or their representatives to reach an agreement.

  8. Documenting and Processing Claims: Claims Handlers maintain detailed records of each claim, including correspondence, investigation reports, and settlement agreements. They ensure all required documentation is completed accurately and update the claims management system with the latest information. They may also coordinate with the finance department to initiate claim payments.

  9. Continuous Learning: Insurance policies, regulations, and industry practices are constantly evolving. Claims Handlers dedicate time to stay updated on changes through training sessions, webinars, or reading industry publications. This helps them enhance their knowledge and maintain their professional expertise.

  10. Handling Multiple Claims Simultaneously: Claims Handlers often manage multiple claims simultaneously, each at different stages of the process. They prioritize their workload based on urgency, complexity, or specific guidelines set by the company.

It's important to note that the day-to-day tasks of an Claims Handler can vary based on the specific company, the type of insurance they handle (e.g., auto, property, health), and whether they specialise in a particular area of the insurance sector.

Are you looking for work as a Claims Handler? If so, check out roles under the 'job' section of this website.