Insurance Claims Management
This
training program provides participants with knowledge and skills related to the
insurance claims department and its functions, claims philosophy, and various
types of reserves, in addition to reviewing methods for combating fraud in
insurance claims, excessive and unjustified payment of claim amounts, and
estimating the claims allowance.
By the end of
this course, participants will be able to:
•
Identify the role of the claims department in the operations of
insurance companies, with the aim of maintaining companies’ profitability.
•
Understanding the claims operations cycle of collecting and analyzing
data, handling claims, and investigating claims to ensure quality requirements
are met.
•
Understanding systems and procedures to ensure the identification of
suspected fraudulent claims for various types of insurance, and identifying
cases of claims leakage.
•
Ability to manage stakeholder relationships, using negotiation best
practices related to claims files and issues, with the goal of retaining
clients.
•
Learn about creating a claim provision and calculating the loss rate.
•
Outlines:
Course Curriculum
- Objectives and importance of the claims department
- Organizational structure for claims management
- Legal requirements for the claim
- Burden of proof
- The cause of the loss is a risk against which it is insured
- Proving the size of the loss
- Main functions of claims management
- Receiving claims
- Claims settlement
- Accident inspection
- Anti-fraud
- Recovery
- Standard coverage of insurance policies
- Parties to the claim (first, second, third)
- Insurance claim reporting forms for a number of insurance policies with practical cases
- Deductible amounts and how to apply them
- Claims settlement methods
- Definition of fraud
- Internal fraud and external fraud
- Indicators of fraud in various types of claims
- Combating fraud in various types of claims
- Claims leakage
- Claims allowance account
- Technical claims provision account
- Calculate the allowance for claims that occurred but were not reported by IBNR
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