Claims Handling Fundamentals

Course Overview

This course enables you to understand the fundamentals of claims handling and apply principles relating to the investigation and the loss adjustment process for property and casualty insurance. Topics include  goals for the claims function,claims department structure,ethics for claims professionals,claims handling process,negotiating claims among others.

Bottom Line Benefits

  • Effectively apply claim principles to your everyday work.
  • Enhance your effectiveness.
  • Demonstrate your value to your organization.

Learning Objectives

Upon successful completion of all the modules in this course, you should be able to:

  • Explain how an insurer’s claims function achieves each of its primary goals: keeping the insurer’s promise and supporting the insurer’s profit goal
  • Describe claims departments in terms of the following: how they can be structured, the types and functions of claims personnel and how their performance can be measured
  • Explain why ethics and professionalism are important to a claim representative.
  • Recognize the ethical and professional concerns that claim representatives face.
  • Explain how each of the following promotes high ethical and professional standards: codes of ethics, quality claim practices, and compliance with laws and regulations.
  • Identify the six activities in the claim handling process.
  • Describe the following activities in the claim handling process: acknowledging and assigning the claim and identifying the policy
  • Describe the activity in the claim handling process that involves contacting the insured or the insured's representative.
  • Describe the following activity in the claim handling process: investigating and documenting the claim.
  • Describe the three bases for legal liability.
  • Describe the following activities in the claim handling process: determining the cause of loss, determining liability and determining the loss amount
  • Describe the following activity in the claim handling process: concluding the claim.
  • Describe the five methods of setting a case reserve and the causes of reserve errors.
  • Describe the four different styles of negotiation and which style is generally best suited for use by claim representatives.
  • Describe the steps in the claim negotiation process.
  • Explain how claimant negotiation variables and claim representative negotiation variables affect claim negotiations.
  • Describe the claim negotiation techniques
  • Describe the negotiation techniques claim representatives should avoid and the reasons those techniques should be avoided.

Module 1: Course Overview

Module 2: Goals of the Claims Function

Module 3: Claims Department Structure, Personnel, and Performance

Module 4: Importance of Ethics and Professionalism for Claim Representatives

Module 5: Recognizing the Ethical and Professional Concerns Claim Representatives Face

Module 6: Codes of Ethics and Quality Claim Practices

Module 7: Case Study - Ethical and Professional Dilemmas of Claim Representatives

Module 8: Overview of the Claim Handling Process

Module 9: Claim Handling Process - Acknowledging the Claim and Identifying the Policy

Module 10: Claim Handling Process-Contacting the Insured

Module 11: Investigating and Documenting the Claim

Module 12: Bases for Legal Liability

Module 13: Determining the Cause of Loss, Liability, and the Loss Amount

Module 14: Claim Handling Process-Concluding the Claim

Module 15: Establishing a Case Reserve

Module 16: Reserving Case Study

Module 17: Negotiating Claims- Styles of Negotiation

Module 18: Claim Negotiation Process

Module 19: Claim Negotiation Variables

Module 20: Overview of Claim Negotiation Techniques

Module 21: Claim Negotiation Techniques to be Avoided

Module 22: Common Pitfalls in Claim Negotiation

Price: $175

This Course includes:

   Text-based content

   4 Weeks