Claims Handling
Purpose
Give agents a fast, compliant workflow to receive, lodge, and follow up on customer claims.
Who Does What
| Role | Key Tasks |
|---|---|
| Agent | Explain process, collect docs, lodge claim, chase outstanding items |
| Claims Ops | Validate docs, order reports, assess liability |
| Medical Officer | Approve / decline CI‑, TPD‑related claims |
| Finance | Issue pay‑outs / letters |
| Team Lead | Escalations & QA |
Five‑Step Process
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Triage & Notify
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Accident / hospital care: customer must notify within 30 days
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Death / TPD / CI: within 6 months
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Check policy in force, waiting periods, exclusions.
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Collect Documents
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Claim form, hospital bills, police / death cert, Attending Physician’s Statement, NRIC & bank details.
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Provide secure upload link.
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Lodge Case (CW system)
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Attach docs, tag claim type, auto‑send acknowledgement with reference #.
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Set diary reminders (D+5 docs, D+15 status).
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Follow‑up & Escalate
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Missing items? Remind customer; flag Team Lead if docs still absent at D+10.
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Red flags (premium arrears, duplicate claim) → note & escalate.
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Outcome & Close
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Approve: inform amount & credit date.
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Reject / part‑pay: cite clause, explain appeal window.
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Update case to Closed‑Paid / Closed‑Declined; e‑file bundle.
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Key SLAs
| Milestone | Target |
|---|---|
| Acknowledge claim | 1 working day |
| Simple claims processed | ≤ 10 working days |
| Complex (CI/TPD) | ≤ 20 working days after final docs |
| Customer callbacks | Same day (before 4 pm) |
Compliance Quick‑Checks
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PDPA: verbal consent before taking medical info.
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Keep files in secure systems only; retain 6 years post‑closure.
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Report suspected fraud to Fraud Surveillance within 24 hrs.
Escalate When…
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Legal threat → Claims Manager (immediate)
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Media inquiry → Corp Comms (1 hr)
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Ex‑gratia > S$10 k → Head of Claims (pre‑decision)
Benefit Figures to Quote (verify in system)
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Hospital Care: S$X/day ward, 3× ICU (60‑day cap)
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PA Assurance: Death S$100 k – S$1 m; medical ≤ S$20 k/accident
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Star Secure Pro: MPV 100–500 % to age 75/80; TPD cap S$6.5 m