Verify commission and fees paid to insurance intermediaries

Match each commission, reward and service fee claim to the payee's registration, the policy that earned it, the board-approved commission policy and the signed contract. Commission Accounting can reverse free-look or mis-sold commission, and the finance controller releases payouts only to registered accounts.

Starts when

Monthly commission run and each invoice from an intermediary or outsourcing vendor.

Runs: Monthly, plus per invoice.

People in the process

CCommission AccountingProcess Owner
DDistribution OperationsParticipating Team
PProcurementParticipating Team
FFinanceParticipating Team
CComplianceParticipating Team
FFinance ControllerParticipating Team
IInternal AuditParticipating Team

The process is a starting point. The standards are yours.

Configure for the insurer, product, distribution model and applicable IRDAI requirements. Claims, underwriting, actuarial and grievance decisions stay with the authorised specialists.

Keep the work connected.

Medical Adjudication

Adjudicate health insurance claims with itemised settlement letters

Check cashless and reimbursement claims against policy coverage, waiting periods, sub-limits, hospital bills and medical records, and tie every deduction to its policy clause. Claims managers can approve, partly pay or repudiate with recorded reasons, and policyholders receive a letter explaining each deduction.

CTCCF

Claims Operations

Investigate and settle life insurance death claims

Verify the policy status, nomination, claimant identity and bank details for each death intimation, and route early or suspicious claims to field investigation against proposal disclosures. The claims review committee can decide repudiations on recorded evidence, and Finance pays interest where settlement runs late.

CCCCF

Premium Accounting

Reconcile daily premium receipts and clear unallocated deposits

Match each collection-account credit to a proposal, renewal or intermediary remittance, and check each policy's risk start date against premium realisation. Finance can apply, refund or move unmatched credits to unclaimed amounts, and the finance controller signs the daily reconciliation.

TPDCF

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Order for the work. Room for the people.