SWICO
Job Title: Claims Field Officer
Department: Claims Department
Reports To: Manager Claims
Duty Station: Head Office / Branches as Assigned
Job Purpose
The Claims Field Officer is responsible for conducting field investigations,
inspections, and assessments of insurance claims to establish the cause, extent,
validity, and admissibility of losses. The role involves evaluating property damage,
motor accidents, bodily injury claims, legal liabilities, and other insured risks to
facilitate fair, accurate, and timely claims settlement while protecting the interests
of Statewide Insurance Company Limited (SWICO) against fraudulent and
unjustified claims.
The position serves as a critical link between claimants, service providers,
investigators, legal representatives, and the Claims Department by providing
professional assessments, claims administration support, and recommendations
that contribute to sound claims decisions, effective risk management, recoveries
management, operational efficiency, and enhanced customer satisfaction.
Key Duties and Responsibilities
1. Claims Assessment, Investigation and Processing
Register and manage claims from notification through assessment to
closure in accordance with company procedures.
Review claim documentation and assess policy coverage, liability, claim
admissibility, and extent of loss.
Conduct field visits and inspections to assess losses arising from motor,
property, engineering, marine, liability, and other classes of insurance
claims.
Investigate claims and determine the nature, cause, extent, and validity of
losses.
Examine damaged vehicles, equipment, buildings, and other insured assets
to determine repair, replacement, or reinstatement requirements.
Assess bodily injury claims through the review of medical reports, police
reports, witness statements, and other relevant documentation.
Obtain all necessary information, evidence, and supporting
documentation required for efficient claims processing.
Interview claimants, witnesses, brokers, agents, repairers, and other
relevant stakeholders to establish facts surrounding claims.
Conduct site visits and accident scene investigations where necessary.
Assess the value of assets involved in claims and provide professional
recommendations on compensation.
Establish, review, and recommend updates to claim reserves in line with
company guidelines and claim developments.
2. Fraud Detection, Recoveries and Risk Management
Identify suspicious claims and investigate potential fraud indicators.
Uncover fraudulent claim schemes and recommend appropriate action.
Recommend claims requiring further investigation to ensure appropriate
resolution.
Support the implementation of fraud prevention and claims risk
management initiatives.
Safeguard SWICO’s interests by ensuring that only genuine and valid claims
are considered for settlement.
Identify and pursue recovery opportunities including subrogation, salvage,
contribution, and other recovery actions.
Monitor recovery cases and follow up with relevant parties to maximize
recoveries and minimize claims leakage.
3. Claims Reporting, Monitoring and Recommendations
Prepare detailed claims assessment and investigation reports within agreed
turnaround times.
Provide recommendations on claim liability, reserve estimates, repair costs,
and settlement values.
Submit comprehensive reports to the Manager Claims to facilitate informed
decision-making.
Monitor claims under assessment and provide regular status updates to
management.
Monitor large, complex, and aged claims and provide analysis and
recommendations for timely resolution
