actuarial science
The rules of applying mathematical and statistical techniques to determine potential or existing risks in various industries, such as finance or insurance.
Insurance claims handlers ensure that all insurance claims are handled accurately and that payment for valid claims is made to the policyholders. They use statistical data and reporting to calculate and adjust claims as needed, communicate with and guide policyholders and monitor the progress of a claim.
Competences and skills
32 ESCO relationsEssential knowledge 6 competences
Occupation specific
0 competencesNo competences in this bucket.
Sector-specific
3 competencesclaims procedures
The different procedures that are used to formally request a payment for a suffered loss from an insurance company.
principles of insurance
The understanding of the principles of insurance, including third party liability, stock and facilities.
Cross-sector
3 competencesfraud detection
The techniques used to identify fraudulous activities.
insurance law
The law and legislation concerning the policies of transferring risks or losses from one party, the insured, to another, the insurer, in exchange for a periodic payment. This includes the regulation of insurance claims and the business of insurance.
types of insurance
The various types of risk or loss transfer policies that exist and their characteristics, such as health insurance, car insurance or life insurance.
Essential skills and competences 13 competences
Occupation specific
1 competencecalculate compensation payments
Calculate the amount due by the insurance company in case of a legitimate claim, authorise the financial transfer and address reclamations to other insurance companies if needed.
Sector-specific
7 competencesanalyse claim files
Check the claim from a customer and analyse the value of the lost materials, buildings, turnover or other elements, and judge the responsibilities of the different parties.
classify insurance claims
Process incoming claims in order to assess their nature and categorise them according to the different types of insurance and claims handling procedures, in order to ensure proper administrative handling, and to guaranee that the claim may proceed to the correct loss adjuster or other claims professionals.
communicate with beneficiaries
Communicate with individuals or organisations who are entitled to receive benefits in the form of funds or other rights in order to obtain information on the procedures, to ensure that beneficiaries receive the benefits they are entitled to, and to provide further information.
handle incoming insurance claims
Manage, process and evaluate submitted requests for insurance in case a problem, which is covered under an insurance policy, occurs. The claim may or may not be approved, based on assessment of the circumstances.
interview insurance claimants
Interview people who have filed claims with the insurance corporation they are insured with, or through specialised insurance agents or brokers, in order to investigate the claim and the coverage in the insurance policy, as well as detect any fraudulous activities in the claims process.
manage claim files
Follow up on the progress of a claim file, keep all parties informed of the status of the file, ensure the customer receives the damages owed, treat any problems or complaints from customers, close the file and give information to an authorised person or department when there is suspicion of fraud.
review insurance process
Analyse all documentation related to a specific insurance case in order to ensure that the application for insurance or the claims process was handled according to guidelines and regulations, that the case will not pose significant risk to the insurer or whether claims assessment was correct, and to assess the further course of action.
Cross-sector
5 competencesapply technical communication skills
Explain technical details to non-technical customers, stakeholders, or any other interested parties in a clear and concise manner.
maintain records of financial transactions
Collate all the financial transactions done in the daily operations of a business and record them in their respective accounts.
organise a damage assessment
Organise a damage assessment by indicating an expert to identify and examine the damage, give information and instructions to experts and follow up on the experts, and write a damage report.
provide financial product information
Give the customer or client information about financial products, the financial market, insurances, loans or other types of financial data.
synthesise financial information
Collect, revise and put together financial information coming from different sources or departments in order to create a document with unified financial accounts or plans.
Optional knowledge 2 competences
Occupation specific
0 competencesNo competences in this bucket.
Sector-specific
0 competencesNo competences in this bucket.
Cross-sector
2 competencesinsurance market
The trends and major driving factors in the insurance market, insurance methodologies and practices, and the identification of the major stakeholders in the insurance sector.
statistics
The study of statistical theory, methods and practices such as collection, organisation, analysis, interpretation and presentation of data. It deals with all aspects of data including the planning of data collection in terms of the design of surveys and experiments in order to forecast and plan work-related activities.
Optional skills and competences 11 competences
Occupation specific
0 competencesNo competences in this bucket.
Sector-specific
3 competencesassess coverage possibilities
Examine the reports dealing with damage appraisal or injury examination in order to verify whether the insured's damages or injuries are covered in their insurance policies, and if they are to assess to which extent they are covered and what settlements the insurer may have to provide.
decide on insurance applications
Assess applications for an insurance policy, taking into account the risk analyses and client information, in order to deny or approve the application and set in motion the necessary procedures following the decision.
estimate damage
Estimate damage in case of accidents or natural disasters.
Cross-sector
8 competencesanalyse financial risk
Identify and analyse risks that could impact an organisation or individual financially, such as credit and market risks, and propose solutions to cover against those risks.
apply statistical analysis techniques
Use models (descriptive or inferential statistics) and techniques (data mining or machine learning) for statistical analysis and ICT tools to analyse data, uncover correlations and forecast trends.
digital
ensure cross-department cooperation
Guarantee communication and cooperation with all the entities and teams in a given organisation, according to the company strategy.
handle customer complaints
Administer complaints and negative feedback from customers in order to address concerns and where applicable provide a quick service recovery.
handle financial disputes
Handle disputes between individuals or organisations, either public or corporate, which deal with financial matters, accounts, and taxation.
handle financial transactions
Administer currencies, financial exchange activities, deposits as well as company and voucher payments. Prepare and manage guest accounts and take payments by cash, credit card and debit card.
manage claims process
Manage the relation with an insurer related to its obligation to receive, investigate and act on a claim filed by an insured.
trace financial transactions
Observe, track and analyse financial transactions made in companies or in banks. Determine the validity of the transaction and check for suspicious or high-risk transactions in order to avoid mismanagement.