Claims Operations Overview

🎯 purpose claims operations governs the end to end operational claims process from first notification of loss through settlement support and closure control activities technical claims decisions relating to liability, indemnity, and settlement quantum remain within the delegated authority framework used by claims assessors this workspace documents the operational processes, routing controls, governance expectations, and service management standards supporting those decisions 🧭 operational process chain receive and register notification capture the claim, validate policy linkage, and acknowledge receipt within operational sla coordinate assessment activity appoint assessors, monitor milestones, and manage dependency tracking throughout the assessment lifecycle execute settlement operations process approved settlement activity, payment execution, and recovery referrals in line with delegated authority controls perform post settlement review complete closure quality checks, confirm file completeness, and capture data for operational reporting and portfolio analysis 📊 service standards and operational controls operational activity service standard fnol acknowledgement 4 business hours assessor appointment 1 working day for property; same day for motor drivable assessment settlement payment execution daily payment cycle operational qa review risk based sampling completed monthly 🛡 governance and operational oversight claims cycle time, leakage management, and first contact resolution are monitored through formal kpi governance operational incidents, backlog breaches, and workflow exceptions are escalated through the claims operations governance forum fraud indicators and control effectiveness are reviewed as part of the enterprise risk and controls framework delegated authority adherence and settlement accuracy are subject to periodic quality assurance review evidence retention standards apply across all stages of the operational claims lifecycle