What does an insurance company’s claims specialist do?

It is for claim settlement. When an insured accident occurs to the insured or his property, the insurance company's claims specialist will conduct an investigation and then verify the claim to see if the claim can be settled. How many.

Specific work content:

1. Investigate and collect evidence, collect, organize and review the damage assessment data;

2. After receiving the notice of damage assessment, Organize customers and relevant personnel to conduct on-site investigation and evidence collection, and determine the loss of insured accidents;

3. Meet with customers, check and determine the validity of property rights, search police and hospital records, and determine liability;

< p>4. Check the claim form and other records to determine the scope of coverage, and conduct compensation adjustments for all claims and agency claims within the scope of responsibility;

5. Reasonably explain the claim settlement conclusions to customers and agents , handle customer feedback regarding loss assessment opinions and claims settlement opinions;

6. Arrange and archive claim documents, establish and maintain claims business database and customer risk files, analyze customer risk distribution, and propose risk management countermeasures, Ensure the authenticity and accuracy of claims information and data;

7. Research claims-related policies, management systems and practical procedures, propose formulation and revision opinions, and continuously improve the quality and efficiency of claims.

Extended information:

Claim settlement process

According to the "Road Traffic Accident Handling Measures" and "Road Traffic Accident Handling Procedures", the following accident handling procedures are specially stipulated:< /p>

On-site investigation:

1. After a traffic accident occurs, if the parties have no dispute over the facts and causes, they can immediately evacuate the scene and negotiate for damage compensation on their own. If you do not evacuate the scene immediately, you must protect the scene and report to the public security organs quickly.

2. After receiving the order, the police on duty must rush to the scene quickly and strictly within the time promised by the system, and deal with the scene quickly.

3. Conduct on-site investigation, including on-site visits, photography, mapping, measurement, inspection and other series of work. On-site inspections must be carried out in accordance with the law, in a timely manner, comprehensively and accurately.

4. After the on-site investigation records are verified to be correct, the parties or witnesses should be required to sign on the site map.

5. For inspection purposes, relevant documents of the vehicle causing the accident and the parties involved may be detained when necessary.

6. Make an appointment with the parties involved to handle the accident.

7. Post-event investigations must be carried out in accordance with the law, including inquiries, trace extraction and inspection, technical testing, damage assessment and other necessary identifications.

Responsibility determination:

1. During the investigation stage, the parties may be summoned for a hearing when necessary.

2. After ascertaining the basic facts of the accident and collecting sufficient evidence, make a determination of liability in strict accordance with the prescribed time and in accordance with the law.

3. When announcing responsibility, all parties involved must be summoned to the table to explain the basic facts of the accident and the reasons and basis for determining responsibility.

4. Inform the parties of their rights and legal limitations to apply for re-identification.

Punishment:

1. After the determination of responsibility becomes legally effective, a penalty opinion should be made on the responsible party and submitted to the leadership for approval.

2. Fill out the penalty ruling based on the penalty decision made by the leader.

3. Announce the penalty decision to the person responsible.

4. Inform the parties of their rights and legal limitations to apply for administrative reconsideration.

5. Improve the relevant procedures for punishment.

6. Implement penalties.

Compensation mediation:

1. Collect certificates, bills, and various materials related to damage compensation.

2. After confirming the completion of the treatment of the injured or determining the damage result, all parties or agents must be organized to conduct compensation mediation within the specified time. The maximum number of mediations is two.

3. After successful mediation, prepare a "Mediation Letter" and send it to the parties respectively.

4. If the mediation is unsuccessful, the "Mediation Termination Letter" must be filled out and sent to the parties, and the parties must be informed that they can file a civil lawsuit with the People's Court within the statutory statute of limitations.

Reference: Baidu Encyclopedia - Insurance Claims Adjuster