Understanding the General Insurance Claims Handling Framework

One of the biggest challenges to professionalism in the insurance industry is the lack of standardised qualifications and training. That’s according to Kerrie Challenor, NTI Chief People and Operations officer.

“There are potential gaps in how various [claims] people are trained,” says Challenor, who is also an ANZIIF (Fellow) CIP.

“Every insurer has a very different process for training their people, and a very different focus. That’s fine until something goes wrong and you realise you don’t actually understand insurance.”

Upgrading the claims function

ANZIIF’s General Insurance Claims Handling Framework, launched in October, promises to change that for the claims handling function in Australia.

Leaders from signatory bodies including Suncorp, Allianz, Youi, SURA, Austbrokers, QBE, Zurich, CHU, IAG, Sedgwick and NTI all agree that a voluntary framework that brings greater consistency across claims handling knowledge and purpose will introduce a higher level of performance and competence, leading to better outcomes for claimants.

The framework is already making a difference within insurance businesses, including at NTI, which was recently awarded ANZIIF’s Claims Team of the Year at the 2023 ANZIIF Insurance Awards.

“At NTI, we make doing the Cert IV with ANZIIF compulsory in all of our insurance operational roles across claims, underwriting and sales roles,” says Challenor. “In addition, NTI has a Claims Academy.”

She says the General Insurance Claims Handling Framework has given the organisation a benchmark against which to measure their own training programs.

“We’re currently reviewing all of our procedures through training and the Claims Academy,” Challenor says.

“We’re doing a training needs analysis for everybody to make sure we haven’t missed any of the requirements that are in the General Insurance Claims Handling Framework, for levels one, two or three.”

Standards at each level 

The framework has been designed to provide standards for all claims handling roles, grouping them into three clusters:

• Licensees, authorised representatives, sub-authorised representatives with decision-making authority
• Licensees, authorised representatives, sub-authorised representatives with no decision-making authority
• Unlicensed insurance fulfilment providers – no decision-making authority

“This is about decision-making authority to make a liability decision on a claim,” Challenor explains. “In our organisation, every claims consultant is able to make a liability position on a claim.

“Of course, the quantum they can make that decision up to varies depending upon their authority level. So, all of our people would fall into group one, but other organisations may operate differently.”

Decision-making authority

Those with decision-making authority are then further separated into:

Level 1: Manager of simple claims

Level 2: Managers of complex claims and/or people leaders

Level 3: Responsible managers

“A responsible manager is an ASIC accreditation at a very senior level,” Challenor says. “They tend to be people who have a broader responsibility across the organisation.”

For example, at NTI, only three people have the responsible manager title: the CEO, the executive general manager — Commercial and Challenor herself as Chief People and Operational Officer.

“We are responsible for ensuring that as an organisation, NTI is doing all the right things in accordance with legislation and responsibilities, and also has the resources, people, skills and abilities to carry out the appropriate insurance functions that we perform,” she says.

But while level three responsible managers usually carry the most responsibility, Challenor says the framework recognises that staff at levels one and two should have a more detailed knowledge of specific claims procedures.

“At Level 1, the focus is going to be on the claims process itself. They must have all of the detailed claims knowledge required to understand the process and product, as well as the claims purpose and philosophy,” she says.

Attending to knowledge gaps

The knowledge gaps that are identified and filled by the framework will vary enormously from business to business, Challenor says.

“The challenge we face as an industry is that ANZIIF’s Cert III, Cert IV and Diploma are not compulsory before you can call yourself an insurance professional,” she says.

“The benefit of this framework is that it ensures all claims people understand the broader context in which they’re operating. It makes sure we understand the financial product we’re advising on, we understand our role, we understand how claims are managed and we understand the philosophy behind insurance, and behind your organisation’s purpose.”

That all adds up to a more engaged and empowered claims professional.

“For customers, I’d hope they notice an increase in professionalism,” Challenor says. “They’ll notice they’re talking to people who know what they’re talking about, regardless of where they work. That’s a much better outcome and it will help intermediaries across the industry, as well.”

Learn more about the ANZIIF claims handling framework qualification