Claims Management
Enaya Insurance Co.
Total years of experience :22 years, 4 Months
Fire and General Accident, Marine, Contracting and Engineering etc. Claims:
Handling day to day operational activities of the FGA department as per the company’s norms, guidelines, policy contract and process with the support of SLA (Service Level Agreement).
Innovating and Supervising the departmental new plans and ideas to implement and to achieve objectives for the company policies and procedure.
Handling and implementing the new process of departmental work complying with the policy terms and conditions of the company and the governmental rules and regulations.
Maintaining the departmental standard as per the multinational norms to run the department on unique level.
Managing the cost control of the incurred claims by proper negotiations, controlling the loss ratio and proper allocation on the departmental budget.
Managing and supervising the technical and operational activities of the non-motor departments
Assessment and Analyze insured locations by the underwriting department
Support to the Underwriting Department in respect of the risk management by carrying out the pre-risk survey
Review of all policies terms, conditions and warranties to check whether the risk has been adequately insured as per the policy procedures.
Evaluating all types of insurance claims validity, assessing the damages, carrying out the surveys, determining the policy liability and processing the approved claim with the RI notifications and approval. Also working in coordination with Compliance Department for identifying and ensuring that the claims has been correctly and adequately measured and the chances of the fraudulent claims have been verified efficiently
Performing review of compliance department’s report with respect to fraudulent activities
Claims Notification to the RI participant as per their share distribution by reviewing the policy contract
Review the system data on weekly basis for the newly incurred claims.
Monthly review on the claims to review and analyze that the reserve amounts have been maintained effectively
Handling the out dating meeting with the team members on monthly basis to understand their issue related to the work and their achievement plans.
Discussing on the objectives of each team member on quarterly basis.
Managing and giving the chance to each team chance to improve their work activities and self-confidence.
Handling proper allocation of task as per the yearly action plan of each member’s strength
Managing the customer’s feedback the departmental work, issues and queries
Facilitating internal & external customers on a range of risk management and insurance activities while dealing with general queries on policies and processes
Maintaining a record of offenders; preparing daily reports by identifying claim cost savings and improving/ fixing the policy compliance issues
Managing FGA, marine & miscellaneous claims as well as WC & life claims; coordinating with customer to get relevant supporting documents related to claims
Monitoring claims; conducting pre-risk surveys as well as investigating the fraudulent and theft claims
Extending support in preparing survey reports, claim recovery statement and the letter of reserve
Working in coordination with an Underwriter; verifying the insurance policy terms, conditions and warranties
Group Life, WC & Medical Claims:
Handling day to day operational activities of the Group Life, WC and Medical claims
Dealing and liaising with the all Takaful departments during the assessment of the claims.
Communicating with the TPA in respect of the approval and rejection parts of the medical claims.
Manage to collect all the relevant data from the Insured in respect of the group life and workmen compensation claims
Liaising with the RI in respect of the approval as per their share allocation.
Motor Claims:
Handled all motor Surveys and Pre-risk Surveys
Liaised with the Agency Garage in respect of the estimation and work order
Handling all types of contracting and errection all risks Claims
Handling FGA, marine and miscellaneous claims
Handling WC & Life Claims
Dealing with the motor claims and surveys
Preparing the list of the documents which may require to progress the claim
Dealing with the customer to arrange to provide us the all relevant supporting documents of the claims
Handling the claims and pre risk surveys
Investigation on the fraudulent and theft claims
Preparing the survey reports
Preparing the Claim Recovery statement and the Letter of Reserve
Loss Adjustment and assessment
Dealing with an Underwriter in respect of the policy
Verification/scrutiny of the insurance policy terms, conditions and warranties
Handling all types of FGA, marine and contracting claims
Handling Motor claims and surveys
Handling all types of pre risk and valuation surveys
Preparation of the survey reports
Dealing with an Underwriter, in respect of the insurance policy
Verification of the insurance policy terms, conditions and warranties
Insurance Companies.
Comply as a Floor Manager and Team Leader
Allocation of the work to the Team Members
Dealing with the Customer and the Claims Department
Dealing with the Sales Team
Worked under Lean Six Sigma Project
Policy Verification.
Policy Signature and Distribution
Preparation of daily report
First Class