Insurance Claims Management Training Course

This course equips participants with practical skills to manage insurance claims fairly, efficiently, and in line with policy terms and regulations. It focuses on claims handling, investigation, assessment, settlement, fraud detection, and claims performance management.

Target Groups

• Claims officers and assessors
• Underwriters and insurance technical staff
• Insurance managers and supervisors
• Loss adjusters and investigators
• Compliance and risk officers
• Customer service staff in insurance companies
• Managers and supervisors seeking to strengthen organizational practice in this field
• Consultants and professionals supporting related organizations

Course Objectives

By the end of this course, participants will be able to:

• Explain the principles of insurance and the claims process
• Interpret policy terms, conditions, and exclusions
• Register and triage claims effectively
• Investigate and verify claims
• Assess losses and quantify settlements
• Apply claims reserving principles
• Detect and manage claims fraud
• Handle disputes and complaints professionally
• Ensure regulatory and ethical compliance
• Monitor claims performance using KPIs

Course Modules

Module 1: Insurance Fundamentals and the Claims Function

• Principles of insurance
• Types of insurance
• Role of claims in the insurance cycle
• Claims stakeholders
• Claims strategy

Module 2: Policy Interpretation

• Policy structure
• Covers, conditions, and exclusions
• Indemnity and subrogation
• Utmost good faith
• Policy disputes

Module 3: Claims Registration and Triage

• Notification and first notice of loss
• Registration procedures
• Claim classification
• Prioritizing complex claims
• Customer communication

Module 4: Claims Investigation and Verification

• Gathering evidence
• Site inspections
• Witness statements
• Working with loss adjusters
• Document verification

Module 5: Loss Assessment and Settlement

• Valuation methods
• Calculating indemnity
• Average and excess
• Settlement negotiation
• Payment and closing procedures

Module 6: Motor, Property, and Health Claims

• Motor claims handling
• Property and fire claims
• Marine and liability claims
• Medical and life claims
• Specialist claim considerations

Module 7: Claims Reserving and Financial Control

• Reserve setting principles
• Case reserves
• Incurred but not reported claims
• Reserve adequacy
• Financial reporting

Module 8: Claims Fraud Detection

• Fraud typologies
• Red flags and indicators
• Investigation techniques
• Working with authorities
• Preventive controls

Module 9: Dispute Resolution, Compliance, and Performance

• Complaints and ombudsman processes
• Regulatory standards
• Ethical claims handling
• Claims KPIs
• Quality assurance

Module 10: Practical Exercises and Capstone Project

• Handling a mock claim from notification to settlement
• Interpreting policy wording in cases
• Assessing losses and calculating payouts
• Identifying fraud indicators
• Presenting a claims performance review