PD 16: Sample Procedures: Insurance Claims Processing

Sample Procedures: Insurance Claims Processing

16.1 Critical Business Function

WHAT

CS01 - Claims Processing (Less maturity and annuity payments)

16.1.1 Pre-Crisis

HOW

Store Claim Schedules, medical-term dictionary, standard letter templates, policy contracts, and payment vouchers at the offsite office.
Coordinate with IT to provide backup for the Claims Management System.

16.1.2 Within T+4 hours (RESUMPTION)

HOW

Grab cheques and important system listings (pre-prepared) in the event of an evacuation.
Require claimants who were informed before the crisis for cheque collection or demanding customers to provide documentary evidence to support their claims.

16.1.3 Within T+4 hours to T+8 hours (RECOVERY)

HOW

Request from claimants who were informed before the crisis for cheque collection to provide documentary evidence to calculate claim amount, .g. Policy Document
Demand that customers whose payments are due on the day of crisis submit documentary evidence.
A policy copy will be extracted from the warehouse for cases without documentary evidence.
- Provide manual Cheque Preparation by Finance.
- Require claimants’ signatures on legal documents as valid discharge and declaration.

16.1.4 After T+8 hours (RECOVERY)

HOW

Access E-Claims to identify cases, outgoing cheques and mail lost in the crisis
Access Claims Tracking system to identify cases (not registered in E-Claims), outgoing cheques and mails lost in crisis
Re-requisition for cheques lost in the crisis.
Re-type letters which were lost in the crisis.
Determine the need to resubmit claims that are in progress.
Claims processing and payment.

16.1.5 RESTORATION

HOW

Update the system with all data which were manually processed during the crisis.
Reconcile claims processed manually during a crisis.
Redirect claim submissions back to the office.
Liaise with Finance on reconciliation of cheques issued during crisis.

Reference

Goh, M. H. (2021). Implementing Your Business Continuity Plan. Business Continuity Management Planning Series (3rd ed.). Singapore: GMH Pte Ltd.

Extracted from "Chapter 16: Sample Procedures: Insurance Claims Processing"

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