Research On The Risk Managements And Controls Of Claims

As an institutional arrangement, insurance company face more risks than other companies. Chinese insurance companies face the competition from both the local companies and international companies after China entered WTO, which forces the insurance companies to pursue expansion blindly while ignoring the management of risks. Within the insurance company, the intention of paying much more attention on business than management is very popular. In this situation, the risks of claims are very critical for insurance companies. However, many insurance companies don't take the risks of claims serious and it's common to see that the organizational structure is not reasonable, institutions and assessment mechanisms are not complete, and the employees are not qualified to manage risks of claims, which threatens the survival of insurance company. In light of this fact, this study explores the issues of risks management of claims for ZY insurance company at Shannxi with in-depth analysis and discussion.This study introduces theories on the risks of claims and risk management first, which provide theoretical foundation for the following analysis. Then, the status of ZY insurance company at Shaanxi's risk management of claims is analyzed with data collection and statistics approach and "soft" and "hard" problems which includes six main problems are discovered:less attention to risk management of claims, the missing of the risk management department of claims in the organizational structure, the incompleteness of the institutions and assessment mechanisms, lack of qualified employees, and the shortage of information system. After that, the risk management system of claims are designed from the perspectives of setting the goal of risk management of claims, designing the organizational structure patterns, designing the risk management mechanisms, designing the risk management processes and the application of information systems on risk management. Next, managerial implications involving the recognization the importance of risk management of claims, completeness of internal control mechanism, optimizing internal process, and innovating managerial tools. The institutional and cultural guarantying measures are emphasized. Last, the main conclusions and the limitations of this study are discussed.