保险理赔服务方案.docxVIP

保险理赔服务方案

目录

1.内容描述................................................3

1.1编写目的.............................................4

1.2服务范围.............................................4

1.3适用对象.............................................6

2.保险理赔服务流程........................................6

2.1投保人报案...........................................7

2.2理赔申请.............................................7

2.3核赔调查.............................................8

2.3.1审核申请资料.....................................8

2.3.2实地调查取证.....................................9

2.4赔款计算与审批......................................10

2.4.1根据合同计算赔款................................12

2.4.2管理人员审批....................................13

2.5赔款支付............................................14

2.5.1直接支付........................................15

2.5.2损失修复支付....................................16

2.6客户回访与服务跟踪..................................17

3.理赔服务团队...........................................18

3.1团队构成............................................19

3.2职责分工............................................20

3.3培训与发展..........................................20

4.理赔服务标准与规范.....................................21

4.1服务时限............................................22

4.2服务质量............................................23

4.3案件处理规范........................................24

5.合作与对接.............................................25

5.1合作机构............................................26

5.2联系渠道............................................27

5.3合作协议............................................29

6.应对特殊案例...........................................30

6.1大额理赔案例........................................31

6.2特殊行业案例........................................32

6.3特别案例处理流程....................................33

7.风险管理...............................................34

7.1案例风险分析........................................35

7.2风险防范措施.............................