Chapter 6 Claims handling systems Flashcards Preview

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Flashcards in Chapter 6 Claims handling systems Deck (43)
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1

What are the three roles of information technology in the claims process?

- Storage

- Production

- Communication of

information

2

Identify five elements which impact the complexity of claims and which IT systems have to be able to handle

Have to process other costs eg loss adjuster fees

If there are co-insurers it adds greater complexity

If brokers are involved

If there is a reinsurance recovery to be made

Insurers need to detect fraudulent claims

3

Identify three elements all claims systems must be able to handle on a volume basis

Claims reserving

Claim payment

Recoveries

 

4

Identify four tasks that claims systems must do.

  1. PROCESS LARGE AMOUNTS OF DATA
  2. PROCESS IT QUICKLY
  3. PROCESS IT ACCURATELY
  4. DELIVER INFORMATION IN A MEANINGFUL MANNER

5

Identify two things an organisatioon must do when improving their claims systems.

•REVIEW CLAIMS PROCEDURES AND IMPROVE IF APPROPRIATE

•BALANCE IT SOLUTION WITH SKILLS OF EXPERIENCED STAFF

6

What are three components which impact the design of a general insurance company claims handling system?

•Structure of company

•Type of business written

•Management decisions about extent of computer systems

7

Ideentify six pieces of claims information that should be recorded bya claims handling system

•Name of policyholder

•Policy No. and claims reference

•Details of claim

•Contacts

•Payments

•Reserves

8

Identify four piecs of underwriting information that shoule be recorded in a claims handling system

•Description of risk

•Description of cover provided

•Supporting risk information

•If more than one insurer - share/pecentage of risk

9

Identify the two principal aims of using Information Technology in the claims process

•REDUCE COST

•IMPROVE SERVICE

10

Identify six benefits of using enhanced information technology in the claims process

•Single data entry

•Reduced use of paper files

•Quicker claims settlement

•Electronic authorization of claims payments

•Increase in communication channels

•Portals and extranets services – self serve

11

Identify six other benefits of using IT in the claims process

•Higher customer retention

•Advice to claims handler

•Streamlined administration – online databases for replacement goods

•Allocation of appointments

•Automatic checking of fraudulent, exaggerate or repeat claims

•Automatic payment of loss adjuster fees

12

Identify seven difficulties which may be encountered through increasing the use of IT in the claims process

•Claims costs can increase

•Complex claims not fit

•May be more difficult, less flexible and expensive than planned

•Adverse cash flow effect a payments made quicker

•Personal service reduced

•Productivity increase but contains not reduce cost

•System must be maintained and up dated– expensive

13

What is teh age for parental consent under the Data Protection Act 2018?

13

14

What is the maximum fine that can be levied under the Data Protection Act 2018

Euro20M or 4% of turnover 

15

The insurer whose customers data is being stored is what a data controller or a data processor 

Data controller

16

To whom does the DAta Protection Act 2018 apply who the Data Parotection Act 1998 did not apply?

Data processors

17

What are the two principal responsibilities of the data controller under the Data Protection Act 2018?

•Determine how and why personal data is processed 

•Must ensure contract with data processors comply with law

18

Identify four types of data the Data Protection Act 2018 applied to:

•Personal data (including IP address)

•Automated

•Manual filed

•Anonymised data

19

Identift the eight categories of personal data to which more stringent conditions apply under the Data Protection Act 2018

•Ethnic or racial origin.

•Political opinions.

•Religious beliefs or other beliefs of a similar nature.

•Trade union membership.

•Genetics

•Biometrics

•Sex life.

- Sexual orientation

20

Identify six principles for the processing of data under the GDPR

•Fairly and lawfully processed

•Processed for limited purposes

•Adequate, relevant and not excessive

•Accurate and up to date

•Not kept longer than necessary

•Processed to ensure security

21

Identify eight rights of the data subject under GDPR

•The right to be informed.

•The right of access.

•The right to rectification.

•The right to erasure.

•The right to restrict processing.

•The right to data portability.

•The right to object.

•Rights in relation to automated decision making and profiling

22

Identify three elements that an insurer expects from a new claims handling system

•PROCESS LARGE AMOUNTS OF DATA

•PROCESS DATA QUICKLY AND ACCURATELY

•PROVIDE INFORMATION IN MEANINGFUL MANNER

23

Identify four elements of flexibility an insurer expects from a new claims handling system

Able to deal with:

•Claim notification

•Involvement of experts

•Correct amount of detail

•Authority levels

24

An insurer has several departments including underwriting, claims IT, marketing is in what type of structure?

Functional

25

What are two advantages of an insurer having a functional structure?

Employees can specialise

Large units are difficult to oordinate

26

What are two disadvantages of an insurer having a functional structure

Inflexibility

Difficult to cordinate

27

When an insurance company has diffent elements which deal with different types of insurance eg personal lines part and a commercial lines part this is known as what type of structure

Divisional

28

What are two advantages of centalising the claims settlement function in a company with a divisional structure?

Required level of expertise is available

Accessing records is easier

29

What are two disadvantages of centralising the claims function in an insurer with a divisional structure 

•Lack of contact between policyholders and local staff

•Delay in settlement

30

Identify six types of orgainsiation which can support an insurer's claims function

•Outsourcing companies

•Loss adjusters

•Disaster recovery companies

•Surveyors

•Solicitors

•Loss assessors