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:
Mapping CBS-2 (Claims Processing & Settlement) enables Malaysian Life Reinsurance to:
The table below maps each Sub-CBS to its operational components to support resilience assessment and scenario testing.
|
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 |
The mapping above supports:
Example severe but plausible scenarios that can now be tested:
By having this structured map, Malaysian Life Reinsurance can assess:
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:
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:
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.
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Building Organisational Resilience: An Operational Resilience Guide for Malaysian Life Reinsurance |
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| eBook 3: Starting Your OR Implementation |
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| CBS-2 Claims Processing & Settlement | |||||
| CBS-2 DP | CBS-2 MD | CBS-2 MPR | CBS-2 ITo | CBS-2 SuPS | CBS-2 ST |
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.
To learn more about the course and schedule, click the buttons below for the OR-300 Operational Resilience Implementer course and the OR-5000 Operational Resilience Expert Implementer course.
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