Program Brief

This training program provides participants with knowledge and skills related to the insurance claims department and its functions, claims philosophy, various types of reserves, as well as a review of methods for combating fraud in insurance claims, unwarranted overpayments of claims amounts, estimating the claims provision, as well as describing the role of reinsurance in managing catastrophic claims.

Program Goals

At the end of the training program, the participant should be able to:

  • Recognize the role of the claims department in the operations of insurance companies to maintain the profitability of companies.
  • Understand the claims operations cycle of data collection and analysis, handling claims and investigating claims to ensure that quality requirements are met.
  • Understanding of the regulations and procedures to ensure the identification of suspicious claims fraudulent for various types of insurance and identification of cases of claims Leakage.
  • The ability to manage relationships with stakeholders using the best negotiating practices relating to files and claims cases.
  • Identify how to Create a claim reserve, calculate the loss ratio and the role of reinsurance regarding the control of catastrophic claims.
Program Agenda
Module 1: Claims Department
  • 1 The objectives and the importance of the claims department

    • 2 Claims department organizational structure

      • 3 The legal requirements of the claim

        • Burden of proof

          • The cause of the loss is an insured risk

            • Proof The size of the loss

            • 4 Main functions at claims department

              • Receipt of claims

                • Claims settlement

                  • Inspection of accidents

                    • Anti-fraud

                      • Recovery

                      Module 2: The Claims Operations Cycle
                      • 1 Standard coverages for insurance policies

                        • 2 The parties to the claim (first, second, third)

                          • 3 Insurance claim forms for a number of insurance policies with case studies

                            • 4 Deductible amounts and how to apply them

                              • 5 Claims settlement methods

                                • Cash payment with case studies

                                  • Repair with case studies

                                    • Replacement with case studies

                                      • Reinstatement with case studies

                                      • 6 Definition of quality and its dimensions

                                        • 7 Quality standards

                                          • 8 Focus on the customer

                                            • 9 Handling complaints efficiently

                                              • 10 Training employees to apply quality standards

                                                Module 3: Combating Fraud in Claims
                                                • 1 Fraud definition

                                                  • 2 Internal and external fraud

                                                    • 3 Fraud Indications in various types of claims

                                                      • 4 Combating fraud in various types of claims

                                                        • 5 Claims Leakage

                                                          Module 4: Managing Relationships with Stakeholders
                                                          • 1 Stakeholders in claims department

                                                            • 2 Negotiating environment

                                                              • 3 Negotiation criteria

                                                                • 4 Planning for effective negotiation outcomes

                                                                  • 5 Contents of the negotiation plan

                                                                    • 6 Best practices in negotiation based on the principle of (Win-Win)

                                                                      Module 5: Claims Reserve Calculation
                                                                      • 1 Technical claims reserve calculation

                                                                        • 2 Incurred but not reported claim reserve IBNR

                                                                          Module 6: Reinsurance
                                                                          • 1 Introduction to reinsurance

                                                                            • 2 Types of reinsurance treaties

                                                                              • 3 The importance of reinsurance in handling catastrophic claims

                                                                                Program Requirements

                                                                                Not Available

                                                                                Program Path

                                                                                Names of the training programs that are integrated (enriched) with the training program:

                                                                                Names of the training programs that after the training program:

                                                                                Program Method
                                                                                • Lecture
                                                                                • Brainstroming
                                                                                • Practical Implementation
                                                                                • Dialogue Teams
                                                                                Evaluation Method
                                                                                • Pre Exam
                                                                                • Post Exam
                                                                                Training Type
                                                                                • Online Training

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