Navigating a Volatile Claims Environment.

The insurance and reinsurance space is susceptible to challenges. In this article l unpack what keeps our clients awake at night, and how Maksure is navigating these challenges to meet customer needs.

Fraud

It is important that the claims personnel should thoroughly look at any and all instances that might lead to any possible fraud incidents. The team needs to be on the lookout for suspicious, missing or incomplete supporting documents, and set controls need to be in place to ensure minimisation of paying fraudulent claims. The claims department remain vulnerable in this area, and should therefore, be vigilant at all times.

Cyber Attack

There is a growing trend of cyber attack on the claims function of insurance and reinsurance companies where fraudsters manipulate systems with the aim of diverting and receiving payout settlements in their accounts. We as Maksure encourage claims and finance personnel to perform a two-step verification process with clients bank account before settlement of claims.

 Sanctions

There is continuous updating of the sanctions list. To avoid claims repudiation based on the sanctions exclusion, insurance and reinsurance companies need to constantly check the relevant channels and platform, and keep abreast of new changes enacted and articulated in the reinsurance contracts.

Currency Fluctuations

Most African currencies remain volatile to the hard currencies, it is therefore imperative to consider currency variations. The tendency is that in the claims or payout process variations may arise in the amounts foreign reinsurers initially stated in comparison to the prevailing rates. It is thus vital to ensure that a currency fluctuation clause is embedded in the reinsurance contracts to ensure that both the reinsured and reinsures are protected.

Interpretation of Policy Wording

The policy wording is the basis of a contractual relationship between the reinsured and reinsurer. It is important that both parties understand the policy wording to avoid complexity, possible litigation at claim stage and improve claims turnaround time. At Maksure, we have taken an approach of continuous training of our clients to ensure accurate interpretation of policy wording.

“At Maksure, we pride ourselves in a world class claims division that we have built. We provide unmatched service and solutions and these have earned us trust with our clients” says Thulani Malungana; Reinsurance Claims Specialist.

Contact our teams on Tel +27 11 805 0086 or Email: info@maksure.co.za.

About Maksure Risk Solutions

Maksure Risk Solutions is an Afro-Global independent specialist insurance and reinsurance broker with business footprint in Africa, Asia, East & Western Europe, South America and the Caribbean. We provide innovative and tailor-made risk solutions in Insurance and Reinsurance as well as Risk Financing and Actuarial Consulting geared towards capital management and strengthening our client’s balance sheet. Maksure is also one of the major players in Captive Management (Establishment & Management) in South Africa, Mauritius, Bermuda and various other jurisdictions. We have access into the Lloyds of London with a deep understanding of African markets. Our global nature ensures that our clients access quality capacity as well as some of the world’s latest thinking and solutions.

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