再保險理賠管理之研究

近年全球氣候異常，天災頻仍，可觀察到災損所致之損失幅度及損失頻率皆有逐年增加之趨勢，有鑒於保險損失逐年攀升，位居保險產業上游角色之再保險業更容易受到全球災損事故的影響和衝擊，如何管理來自各分出公司依循各類再保險合約下所生之賠案，在此更顯得重要。本研究以再保險理賠為主軸，透過蒐集目前再保險市場現況，分析再保險理賠管理之意涵，由再保險理賠的組織、潛在賠案的介紹、審查及折算之應用切入，繼而歸納傳統理賠管理與現代理賠管理的主要變革，說明現代再保險理賠作業管理之應用，如何藉由授權與知識傳遞、專業人員運用、核保與理賠系統之相互支援及準備金設定，來達到與傳統理賠管理不同之層次，進而發揮再保險理賠管理之功能。

關鍵字

再保險；理賠；理賠管理；再保險理賠管理

並列摘要

In recent years, due to global climate anomalies and frequent natural disasters, we can observe that the loss severity and frequency both increase year by year trend. In view of the insured losses rose year by year, reinsurer, as an upstream role of the insurance industry, its operation result was influenced by the global catastrophe loss hugely. Thus it becomes more and more important to manage the claims for reinsurers. This research focuses on “Reinsurance Claims Management”. We analyzed the meaning and significance of the subject by reviewing current reinsurance market. We also summarized the difference between traditional and current reinsurance claims management skills by considering the organization of reinsurance claims, the latent claims, audit and the application of commutation. After we reviewed this research, we will realize how we reach a different level from traditional to modern claims management by pass through the authorization and knowledge, giving mutual support in underwriting and claims system, making good use of professional consultants, and improving reserve-setting skills.