Client Complaint Resolution for Insurance
Receives, investigates, and resolves policyholder complaints through a structured escalation and resolution process.
Aligns with ASIC regulatory requirements, General Insurance Code of Practice, and AFSL obligations. Includes audit trail provisions.
Workflow Stages
Dispute Intake
Receive and document the dispute, acknowledge it to the policyholder, and assign an owner.
Inputs
- Policyholder dispute submission
- Policyholder account information
- Dispute classification guide
Outputs
- Logged dispute record
- Acknowledgment sent to policyholder
- Dispute owner assigned
Investigation
Research the dispute by reviewing relevant records, speaking with involved parties, and identifying root causes.
Inputs
- Dispute record
- Service settlement logs
- Team member statements
Outputs
- Investigation findings
- Root cause analysis
- Recommended resolution options
Decision Points
- • Is the dispute valid?
- • Is this a systemic issue or isolated incident?
Resolution Proposal
Develop and present a resolution proposal to the policyholder, including corrective actions and any compensation offered.
Inputs
- Investigation findings
- Resolution authority limits
- Policyholder relationship context
Outputs
- Resolution proposal document
- Compensation offer if applicable
- Policyholder communication prepared
Decision Points
- • Does the resolution require management approval?
- • Is compensation warranted?
Resolution Implementation
Execute the agreed resolution including any service corrections, process changes, or compensation.
Inputs
- Approved resolution plan
- Resource allocation
- Implementation timeline
Outputs
- Resolution actions completed
- Compensation delivered
- Process corrections applied
Follow-Up and Closure
Confirm the policyholder is satisfied with the resolution and close the dispute record.
Inputs
- Resolution completion confirmation
- Policyholder contact details
- Satisfaction survey
Outputs
- Policyholder satisfaction confirmed
- Dispute record closed
- Improvement recommendation logged
Frequently Asked Questions
How quickly will the policyholder receive an acknowledgment?
Complaints are acknowledged within 4 business hours of receipt, with an assigned owner and expected resolution timeline communicated to the policyholder.
Are complaints tracked for trend analysis?
Yes, all complaints are categorized and analyzed monthly to identify systemic issues and drive process improvements.
What if the policyholder is not satisfied with the proposed resolution?
The dispute is escalated to a senior manager who will work directly with the policyholder to find an acceptable alternative resolution.
Ready to implement this workflow in your business?
Our team can implement this workflow into your business operations with custom tools and training.