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What do you recommend on who conduct internal audit for claim adjuster and compensation department at insurance company?

بماذا تنصح الذين يجرون التدقيق الداخلي لمسوي المطالبات وقسم التعويضات في شركة التأمين؟

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Question added by Waqayan Al Waqayan , Secretary of Sharia Supervisory Board (SSB) , Ahli United Bank (AUB)
Date Posted: 2013/08/05
Deleted user
by Deleted user

It just happened that Insurance companies are my least favorite type of audit that I would like to participate in ! Having said that the following is my answer : Claims fraud is a major risk risk in insurance companies ,this could take two forms: - claims being submitted when an insurable event has not occurred - inflated claims being submitted for genuine events The internal auditors need to focus their attention to : - The claim department employes highly experienced ,honest and objective specialists - There are sufficient and effective policies and procedures in place - Segregation of duties and responsibilities relating to claims processing /approval and payment is practiced - Fraud red flags are identified at an early stage - proper invistigations are undertaken on timely basis - A claims register is maintained and is accurate and up to date - Outstanding loss reserves are adequate at any point of time -Proper monitoring system is in place to record accumulation of claims arising from a particular event or within a particular period -Estimates of preliminary loss reserves are reasonable, regularly reviewed and updated upon receipt of fresh and relevant information The list could go and on ,with the limited time I have I will strict my answer to the above.
Sources: Lauban financial service Authority, Barclay Simpsons 's introduction to internal audit in insurance companies.

mohammed saied hassan ahmed
by mohammed saied hassan ahmed , مهندس زراعي , هندسة زراعية

Precision and focus

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