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CBS-2 Claims Processing & Settlement
Introduction
![[OR] [MLRE] [E3] [CBS] [2] [MPR] Map Processes and Resources](https://no-cache.hubspot.com/cta/default/3893111/048b10e9-8823-4add-8968-81473caadce5.png)
This chapter presents the detailed Mapping of Processes and Resources for the Critical Business Service (CBS-2): Claims Processing & Settlement of Malaysian Life Reinsurance.
In line with operational resilience principles — as articulated by Bank Negara Malaysia (BNM) in its 2025 Discussion Paper on Operational Resilience — financial institutions are expected to:
- Identify their Critical Business Services (CBS)
- Map end-to-end processes and interdependencies
- Identify supporting resources (people, technology, facilities, data, third parties)
- Understand vulnerabilities to severe but plausible disruptions
- Support scenario testing and impact tolerance validation
Mapping CBS-2 (Claims Processing & Settlement) enables Malaysian Life Reinsurance to:
- Understand the full lifecycle of reinsurance claims
- Identify single points of failure
- Assess concentration risks (technology, people, vendors)
- Support scenario testing (e.g., system outage, fraud incident, third-party failure)
- Ensure timely settlement and market confidence
The table below maps each Sub-CBS to its operational components to support resilience assessment and scenario testing.
![Banner [Table] [OR] [E3] Map Dependency](https://no-cache.hubspot.com/cta/default/3893111/8a44ad9d-681b-48ff-90b1-b994a1c12a64.png)
Table P3: Map Processes and Resources for CBS-2
|
Sub-CBS Code |
Sub-CBS |
Processes |
People |
Technology (Applications & Infrastructure) |
Third-Party Vendors |
Upstream / Downstream Dependencies |
|
2.1 |
Claim Notification & Receipt |
Receive cedant claim notification; register claim; assign claim ID; acknowledge receipt |
Claims Intake Officers; Client Relationship Managers |
Reinsurance Core System; CRM; Email Gateway; Secure File Transfer; Document Management System (DMS); Data Centre/Cloud |
IT hosting provider; Secure email provider |
Upstream: Cedant insurers; Brokers Downstream: Verification team |
|
2.2 |
Document & Data Verification |
Validate claim documents; check treaty coverage; confirm completeness; KYC/AML screening |
Claims Administrators; Compliance Officers |
Core Reinsurance System; DMS; AML Screening Tool; Policy Admin System; Identity Verification Tools |
AML solution vendor; Identity verification vendor |
Upstream: Claim intake Downstream: Triage & Assessment |
|
2.3 |
Preliminary Assessment & Triage |
Categorise claim (standard/complex/high-value); assess treaty applicability; risk flagging |
Claims Analysts; Senior Claims Executives |
Workflow Management System; Risk Scoring Engine; Claims Analytics Dashboard |
Risk analytics vendor |
Upstream: Verification Downstream: Detailed assessment or investigation |
|
2.4 |
Detailed Claims Assessment |
Policy & treaty analysis; actuarial review; financial impact assessment; fraud risk review |
Senior Claims Managers; Actuaries; Legal Advisors |
Actuarial Modelling Software; Core Reinsurance System; Financial Modelling Tools; Secure Data Repository |
Actuarial software vendor |
Upstream: Triage Downstream: Third-party engagement or decisioning |
|
2.5 |
Third-Party Engagement & Investigation |
Engage medical assessors; forensic review; external legal consultation; loss adjusters |
Claims Investigation Team; Legal Counsel |
Case Management System; Secure Collaboration Platform |
Medical assessors, Forensic investigators, External law firms |
Upstream: Assessment Downstream: Decisioning |
|
2.6 |
Claims Decisioning & Approval |
Approval workflow; authority limit check; committee review for large claims |
Claims Committee; Chief Underwriting Officer; CFO (for large exposures) |
Approval Workflow System; Delegation of Authority Matrix; Digital Signatory Platform |
Digital signature provider |
Upstream: Assessment/Investigation Downstream: Settlement processing |
|
2.7 |
Settlement Calculation & Fund Disbursement |
Calculate payable amount; FX conversion (if applicable); accounting entry; payment release |
Finance Department; Treasury; Claims Finance Officer |
Financial Accounting System; Payment Gateway; SWIFT Interface; Banking Platform; ERP |
Banking partners; Payment gateway provider |
Upstream: Approved claim Downstream: Cedant account crediting; Reporting |
|
2.8 |
Claim Communication & Reporting |
Issue decision letters; notify cedants; provide settlement breakdown; update brokers |
Client Servicing Team; Corporate Communications |
CRM; Email Systems; Reporting Tools; Secure Client Portal |
Communication platform vendor |
Upstream: Settlement Downstream: Record archival; Management reporting |
|
2.9 |
Record Archival & Compliance Reporting |
Archive claim records; regulatory reporting; audit trail maintenance |
Compliance Officers; Internal Audit |
Document Archival System; Regulatory Reporting Module; Backup & Disaster Recovery Systems |
Cloud storage provider; External auditor |
Upstream: Communication Downstream: Regulatory bodies; Internal audit |
|
2.10 |
Continuous Improvement & Analytics |
Claims trend analysis; root cause analysis; performance review; scenario testing; resilience review |
Risk Management Team; Data Analysts; Operational Resilience Lead |
Business Intelligence Platform; Data Warehouse; Risk Dashboard; Scenario Testing Tools |
BI software vendor; External consultants |
Upstream: All claims data Downstream: Risk Committee; Board; Strategy Planning |
Alignment with BNM Operational Resilience Expectations (2025 Discussion Paper)
The mapping above supports:
- Identification of Important Business Services (IBS/CBS)
- Resource Mapping (People, Process, Technology, Third Party)
- Interdependency Mapping
- Scenario Testing Preparation
Example severe but plausible scenarios that can now be tested:
- Core Reinsurance System outage during high-volume claims period
- Cyberattack affecting claims documentation repository
- Failure of the payment gateway provider is delaying settlement
- Loss of key actuarial staff during a catastrophe event
- Cloud infrastructure disruption is impacting document access
By having this structured map, Malaysian Life Reinsurance can assess:
- Maximum tolerable disruption for claims settlement
- Recovery Time Objectives (RTO)
- Recovery Point Objectives (RPO)
- Substitutability of vendors
- Concentration risk across infrastructure
![Banner [Summing] [OR] [E3] Map Processes and Resources](https://no-cache.hubspot.com/cta/default/3893111/61e5330e-051c-4874-b6da-a1be8393c283.png)
The mapping of processes and resources for CBS-2: Claims Processing & Settlement provides Malaysian Life Reinsurance with a comprehensive end-to-end view of its claims value chain.
This structured mapping:
- Identifies critical dependencies
- Supports scenario testing
- Enables vulnerability assessment
- Reduces single points of failure
- Strengthens governance oversight
- Enhances confidence among cedants, regulators, and stakeholders
Operational resilience is not merely about recovery — it is about maintaining the ability to deliver critical services under severe but plausible disruptions.
By systematically mapping CBS-2, Malaysian Life Reinsurance establishes the foundation for:
- Impact tolerance calibration
- Scenario testing execution
- Remediation planning
- Continuous resilience improvement
This chapter, therefore, serves as a core building block in strengthening the organisation’s operational resilience framework and ensuring sustainable claims servicing capability even during systemic stress events.
ly strengthen its underwriting capabilities against severe but plausible disruptions. By maintaining this map as a living artefact, MLRe reinforces its ability to adapt, recover, and continue serving cedants while meeting regulatory and stakeholder expectations for operational resilience.
![[OR] [MLRE] [E3] [CBS] [2] [DP] Claims Processing & Settlement](https://no-cache.hubspot.com/cta/default/3893111/fa2b8c5e-59f3-4868-a847-c5debe25ae40.png)
![[OR] [MLRE] [E3] [CBS] [2] [MD] Map Dependency](https://no-cache.hubspot.com/cta/default/3893111/18d7ac36-ab95-4332-93c1-dbc1a6302a3b.png)
![[OR] [MLRE] [E3] [CBS] [2] [ITo] Establish Impact Tolerances](https://no-cache.hubspot.com/cta/default/3893111/10c27e92-7ff4-4d19-b55c-c22e980f5cdb.png)
![[OR] [MLRE] [E3] [CBS] [2] [SuPS] Identify Severe but Plausible Scenarios](https://no-cache.hubspot.com/cta/default/3893111/ab5ccead-fc84-4c45-97a7-8eae692d6526.png)
![[OR] [MLRE] [E3] [CBS] [2] [ST] Perform Scenario Testing](https://no-cache.hubspot.com/cta/default/3893111/adb3fe63-90b0-4417-b83e-aa17b6cfd30a.png)
For organisations looking to accelerate their journey, BCM Institute’s training and certification programs, including the OR-5000 Operational Resilience Expert Implementer course, provide in-depth insights and practical toolkits for effectively embedding this model.
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