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    Title: 保險公司理賠員生涯發展、人格特質與工作壓力之研究
    Other Titles: A study on career development, personality traits and working pressure of claim handlers in Taiwanese insurance companies.
    Authors: 張育瑞;Chang, Yu-jui
    Contributors: 淡江大學保險學系保險經營碩士在職專班
    林麗銖;Lin, Li-chu
    Keywords: 理賠員;生涯發展;人格特質;工作壓力;Claim Handlers;Career Development;personality traits;Working pressure
    Date: 2010
    Issue Date: 2010-09-23 16:01:03 (UTC+8)
    Abstract: 近年來,由於國民經濟水準提高,人民教育普及,投保率增加,且隨著經濟及社會的發展,國內保險業已快速成長為金融體系中不可或缺的一環。如果核保被視之為保險公司的守門員,那麼理賠就是保險公司的帳房了。
    理賠員在保險公司中所占人數較少,但對於保險公司經營過程中的風險控管常扮演著非常重要的角色,故本論文主要探討的內容為保險公司理賠員生涯發展、人格特質與工作壓力之研究,希望藉此論文能夠讓大眾更理解理賠員的工作內容及性質,並且讓保險公司能瞭解理賠人員目前所面臨的問題及壓力,而理賠人員人格特質的部分亦能作為日後保險公司人力資源部門晉用新進人員的參考,進而重視理賠員的生涯規劃,改善理賠實務工作環境,與人才培育。
    依據本研究瞭解,理賠是一份專業且富有挑戰性的工作,最大的壓力與困難,依序為:
    1.理賠員與保戶(廠商)對病歷(或公證報告)的內容解讀不同,產生理賠上的 爭議。
    2.集團式的詐欺行為與遭人恐嚇施壓。
    3.疑似有道德風險案件,檢警不願配合提供相關資料。
    一位傑出的理賠人員應具備,1.良好的溝通能力,2.高度的抗壓性,3.穩定的情緒控制力等人格特質。
    並針對研究之發現,對保險公司人力資源、主管機關及理賠員提出相關建議,期望未來各家保險公司,除了重視理賠績效,降低理賠率外,亦對理賠人員的工作環境,生涯發展,工作壓力的釋放,後續人才的培育,藉由本次的研究,能發現更良善的方法。
    In recent years, the level of the national economy is raised, and the education is popular, so that the insurance rate is increased. With the development in economy and society, the domestic insurance industry has quickly become an integral part of financial system. If the underwriting in insurance company is regarded as a goalkeeper, the claim in insurance company is an accountant.

    In an insurance company, there are only few claims handlers, but they usually play very important roles in the risk management of company. Therefore, this thesis mainly focuses on career development, personal characters, and working pressure of insurance claims handlers. Through this thesis, we would provide people with better understanding on the working contents of the claims handlers and also let insurance companies realize the problems and pressures that claims handlers are facing. The personal characters of claims handlers could be used for Human Resource Department’s reference for the recruitment of employees. Career development of claims handlers and claims working environment improvement and personnel training.

    Based on this research, claims handling is a professional and challenging work, the most pressure and the difficulties were:
    1. The different interpretation on medical records (or notarized report)between claims handlers and policy holders (manufacturers), result in arguments on claims handling .
    2. Syndicated fraud and intimidation.
    3. Prosecutors and police do not provide relevant information in suspected moral hazard cases.

    An outstanding claims handler should have the following characters: 1. Good communication skills, 2. High pressure resistance, 3. Emotional stability.

    Based on the findings of this study, we make recommendations to human resources unit of insurance companies, the competent authority and claims handlers , and expect that in the future, insurance companies not only take account of performance of claims handling and reduce loss ratio , but also find better ways to improve working enviroment circumstance, career development, pressure relief and personnel training.
    Appears in Collections:[保險學系暨研究所] 學位論文

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