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Rqbe - V 2.04 Claims 2021-22-Updated
Rqbe - V 2.04 Claims 2021-22-Updated
Frequency of
Annually or material changes to business operations
review:
Approval date:
suman.pal@rahejaqbe.com
Signed:
Suman Pal
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CONTENTS
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1. BIA Summary
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Document Control
Date Revision / Amendment Details & Reason Author
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2. Business Unit Overview
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[Add more lines if you need them, and change the headings if they are not appropriate to your business area e.g. if your
business area has a different structure to the one listed.]
STRUCTURE CHART
Suman Pal
Chief Claims Officer Kaushal Shah (Legal Claims)
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3. Function Analysis
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[What functions in your business unit are involved in delivering these objectives? Collectively these functions should align with achieving
all objectives]
Functions / Activities
Ref Business function Sub-process Key contact person
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5. Customer Dependency
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Business function Sub-process Major customer / Minimum contracted, Key contact of Comments
stakeholder expected or acceptable consumer
Claims - manual review - All LoB's Manual Review Insured, Business
partners,regulator
Claims portfolio management- All Portfolio Management Insured, Compliance,
LoB's CxO's
Claims technical review- All LoB's Technical Review Insured, CxO's,
Compliance, Regulator
Claim referral Assessment /Evaluation Insured, Business
assessment/evaluation partners,CxO's, Local
entities
Service provider review and Performance Management Insured, Business
appointment partners,Compliance,
Regulators
Claim Settlement process- Claim Intimation Insured, Business
Intimation partners,Compliance,
Regulators
Claim Settlement process- Vendor Vendors(Garage ,Surveyor, Insured, Business partners,
Appointment Investigator, Advocate) Regulators
Claim Settlement process - Claim Claim Settlement Insured, Business partners,
Settlement Regulators
Claim Settlement process- Claim Claim Payment processing Insured, Business partners,
Payment processing Regulators
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6. Impact Assessment
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Business function Sub-process Highest Impact Maximum Tolerable Critical Recovery Time Recovery Point Recovery Level
(Provide a description of the Period of Disruption Business Objective (RTO) Objective (RPO) Objective (RLO)
1 - 4 Weeks
1 - 4 Weeks
1 - 4 Weeks
1 - 4 Weeks
1 - 4 Weeks
1 - 4 hours
1 - 4 hours
1 - 4 hours
1 - 4 hours
1 - 4 hours
basis and quantum of (MTPD) - hours / days Function hours / days
> 1 Month
> 1 Month
> 1 Month
> 1 Month
> 1 Month
2 - 7 Days
2 - 7 Days
2 - 7 Days
2 - 7 Days
2 - 7 Days
<1 hour
<1 hour
<1 hour
<1 hour
<1 hour
highest rated impact) Y/ N
1 Day
1 Day
1 Day
1 Day
1 Day
Claims - manual review - All LoB's Manual Review L L L M H C L M H C C C M M H C C C L C C C C C L L L L L L C 4 hours Y 2 hours 2 hours 100%
Claims portfolio management- All Portfolio Management L L L M H C L M M C C C M M H H H C M H H C C C L L L L L L C 4 hours Y 2 hours 2 hours 100%
LoB's
Claims technical review- All LoB's Technical Review L L L M C C L L M H C C M M H H H C M M M H C C L L L L L L C 2 days Y 1 day 1 day 100%
Claim referral Assessment /Evaluation L L L M H C L M M H C C M M H H C C L M M H H C L L L L L L C 4 hours Y 2 hours 2 hours 100%
assessment/evaluation
Service provider review and Performance Management L L L M H C L L M H C C L L L M H C L L L M H C L L L L L L C 7 days Y 3 days 2 days 100%
appointment
Claim Settlement process- Claim Intimation L M H C C C L M H C C C L M C C C C M H C C C C L L L L L L C 4 hours Y 2 hours 2 hours 100%
Intimation
Claim Settlement process- Vendor Vendors(Garage ,Surveyor, Investigator, L M H C C C L M H C C C L M H C C C M H C C C C L L L L L L C 4 hours Y 2 hours 2 hours 100%
Appointment Advocate)
Claim Settlement process - Claim Claim Settlement L M H C C C L M H C C C L M H C C C M H C C C C L L L L L L C 4 hours Y 2 hours 2 hours 100%
Settlement
Claim Settlement process- Claim Claim Payment processing L M H C C C L M H C C C L M H C C C M H C C C C L L L L L L C 4 hours Y 2 hours 2 hours 100%
Payment processing
Claims Settlement Process- Preparation of assessment through Invoice M H C C C C M H C C C C L M H C C C M H C C C C L L L L L L C 4 hours Y 2 hours 2 hours 100%
Assessmet BOT & pre-invoice
Claims Settlement Process- Payment Requisition number generation M H C C C C M H C C C C L M H C C C M H C C C C L L L L L L C 4 hours Y 2 hours 2 hours 100%
Paymnent Requisition number through BoT from final assessment sheet
generation through BoT
Claim Intimation BoT Generation of P400 Claim number through M H C C C C M H C C C C L M H C C C M H C C C C L L L L L L C 4 hours Y 2 hours 2 hours 100%
BoT
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4. Demand Analysis
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7. Supplier Dependency
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Business Function Sub-process Critical RTO Supplied product or service Minimum acceptable Supplier contact Alternate supplier contact
Business product or service details details (if known)
Function
Y/ N
Claims - manual review - All LoB's Manual Review Y 2 hours Claims Files Required; Information All data required
from Insureds/Surveyors/
Investigators/Lawyers /
Intermediaries. etc
Claims portfolio management- All Portfolio Management Y 2 hours Claims Files Required; Information All data required
LoB's from Insureds/Surveyors/
Investigators/Lawyers / COE etc
Claims technical review- All LoB's Technical Review Y 1 day Claims Files Required; Information All data required
from Uws/Insureds/Surveyors/
Investigators/Lawyers/Operations/
IT etc
Claim referral Assessment /Evaluation Y 2 hours Claims Files Required; Information All data required
assessment/evaluation from Advocates/Surveyors/
Investigators etc
Service provider review and Performance Management Y 3 days IRDAI approved list of Surveyors. All data required
appointment Empanelled list of
advocates/surveyors/investigators/r
epairers
Claim Settlement process- Claim Intimation Y 2 hours Claims intimation data from IT is All data required
Intimation required
Claim Settlement process- Vendor Vendors(Garage ,Surveyor, Investigator, Y 2 hours Data from IT is required All data required
Appointment Advocate)
Claim Settlement process - Claim Claim Settlement Y 2 hours Claims settlement data from IT is All data required
Settlement required
Claim Settlement process- Claim Claim Payment processing Y 2 hours Claim payment data is required All data required
Payment processing from IT & Finance
Claims Settlement Process- Preparation of assessment through Invoice Y 2 hours Data/Report from IT is required All data required
Assessmet BOT & pre-invoice
Claims Settlement Process- Payment Requisition number generation Y 2 hours Data/Report from IT is required All data required
Paymnent Requisition number through BoT from final assessment sheet
generation through BoT
Claim Intimation BoT Generation of P400 Claim number through Y 2 hours Data/Report from IT is required All data required
BoT
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8. Personnel Requirements
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Claims - manual review - All LoB's Sub-process Critical RTO (days) BAU staffing BAU location and Resource requirements Remarks Comments
Business level staffing levels (Minimum levels required to complete critical business functions / processes)
Function (available to
Y/ N complete key
business
processes) <1 hour 1 - 4 hours 1 Day 2 - 7 Days 1 - 4 Weeks > 1 Month
WFH Physical WFH Physical WFH Physical WFH Physical WFH Physical WFH Physical
Seat Seat Seat Seat Seat Seat
Claims - manual review - All LoB's Manual Review Y 2 hours 5 Work From Home- 5 5 5 12:00:00 AM 5 5 Work from Home
Digitally
Claims portfolio management- All LoB's Portfolio Management Y 2 hours 5 Mumbai 5 5 5 5 5 Corporate Office
Claims technical review- All LoB's Technical Review Y 1 day 4 Work From Home- 4 4 4 4 4 Work from Home
Digitally
Claim referral assessment/evaluation Assessment /Evaluation Y 2 hours 4 Work From Home- 4 4 4 4 4 Work from Home
Digitally
Service provider review and appointment Performance Management Y 3 days 2 Work From Home- 1 1 1 1 1 Work from Home
Digitally
Claim Settlement process- Intimation Claim Intimation Y 2 hours 4 Work From Home- 4 4 4 4 4 Work from Home
Digitally
Claim Settlement process- Vendor Appointment Vendors(Garage ,Surveyor, Y 2 hours 4 Work From Home- 4 4 4 4 4 Work from Home
Investigator, Advocate) Digitally
Claim Settlement process - Claim Settlement Claim Settlement Y 2 hours 4 Work From Home- 4 4 4 4 4 Work from Home
Digitally
Claim Settlement process- Claim Payment Claim Payment processing Y 2 hours 4 Work From Home- 4 4 4 4 4 Work from Home
processing Digitally
Claims Settlement Process- Assessmet BOT Preparation of assessment Y 2 hours 15 Work From Home- 15 15 15 15 15 Work from Home Four resource from each region and 3
through Invoice & pre- Digitally resource of HO
invoice
Claims Settlement Process- Paymnent Payment Requisition number Y 2 hours 15 Work From Home- 15 15 15 15 15 Work from Home Four resource from each region and 3
Requisition number generation through BoT generation through BoT from Digitally resource of HO
final assessment sheet
Claim Intimation BoT Generation of P400 Claim Y 2 hours Work From Home- 4 4 4 4 4 Work from Home 1 resource each from region and 1
4
number through BoT Digitally resources from HO
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9. ICT Dependency
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Network directory
Adobe Acrobat
Tax Integrator
Physical mail
Lotus Notes
Paper Files
File Server
Telophony
Longview
Quantum
Scanner
Outlook
Intranet
Internet
Auskey
QSTAR
Printer
Copier
Citrix
D2A
Claims - manual review - All LoB's Y 2 hours 1 x x x x x x x x x Work from Home Email, address book, MS Teams, MS Office, Network
directory and Citrix to be available within 2 hours
Claims portfolio management- All Y 2 hours 1 x x x x x x x x x Corporate Office Email, address book, MS Teams, MS Office, Network
LoB's directory and Citrix to be available within 2 hours
Claims technical review- All LoB's Y 1 day 1 x x x x x x x x x Work from Home Email, address book, MS Teams, MS Office, Network
directory and Citrix to be available within 4 hours
Claim referral Y 2 hours 1 x x x x x x x x x Work from Home Email, address book, MS Teams, MS Office, Network
assessment/evaluation directory and Citrix to be available within 2 hours
Service provider review and Y 3 days 1 x x x x x x x x x Work from Home Email, address book, MS Teams, MS Office, Network
appointment directory and Citrix to be available within 2 hours
Claim Settlement process- Y 2 hours 1 x x x x x x x x Work from Home Email, address book, MS Teams, MS Office, Network
Intimation directory and Citrix to be available within 4 hours
Claim Settlement process- Vendor Y 2 hours 1 x x x x x x x x x Work from Home Email, address book, MS Teams, MS Office, Network
Appointment directory and Citrix to be available within 2 hours
Claim Settlement process - Claim Y 2 hours 1 x x x x x x x x x Work from Home Email, address book, MS Teams, MS Office, Network
Settlement directory and Citrix to be available within 2 hours
Claim Settlement process- Claim Y 2 hours 1 x x x x x x x x Work from Home Email, address book, MS Teams, MS Office, Network
Payment processing directory and Citrix to be available within 2 hours
Claims Settlement Process- Y 2 hours 1 x x x x x x x Work from Home Email, address book, MS Teams, MS Office, Network
Assessmet BOT directory and Citrix to be available within 2 hours
Claims Settlement Process- Y 2 hours 1 x x x x x x x Work from Home Email, address book, MS Teams, MS Office, Network
Paymnent Requisition number directory and Citrix to be available within 2 hours
generation through BoT
Claim Intimation BoT Y 2 hours 1 x x x x x x x Work from Home Email, address book, MS Teams, MS Office, Network
directory and Citrix to be available within 2 hours
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10. Recovery Strategy
Business function Sub-process Critical RTO (days) RPO Destruction of Permanent Permanent Temporary Temporary Temporary Temporary Temporary Temporary Temporary What critical What critical What Comments
Business building and loss of key loss of key loss of vital IT loss of vital IT loss of vital denial of denial of unavailability unavailability tasks / tasks / alternative
Function permanent loss of staff dependencies (data) (voice) (non- access to access to of key staff of key activities / activities / processes or
Y/ N vital IT (data and electronic) building precinct dependencies processes can processes workarounds
voice), vital non- records be performed cannot be can be
electronic records performed employed
and precinct.
Example Y Diversification, Diversification, Diversification, Diversification Recover from Diversification, Diversification, Diversification
Replication, Remote Cross-training, Remote Access brokers Remote Access Remote Access
Access, Alternate DTPs
Site
(Date: Attendees)
Commercial Claims
Manual.pdf
Motor Claims
Motor OD
Manual.pdf
Health Claims
Health Claim
Manual-Final.pdf