Claim Handling Fundamentals

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Level: Beginner

Why you need this course:
After completing this course, you'll have a basic overview of the claim handling process, the people involved in that process, and the skills required to be an efficient claim professional.

Upon successful completion of this course, you should be able to:

  • Describe the parties to insurance policies, the roles those parties play, and others who might benefit from the policies.
  • Identify the activities in the claim handling process.
  • Describe the roles of the following claim personnel and others who help handle claims:
      • Managers
      • Supervisors
      • Claim representatives
      • Customer service representatives
      • Other support staff
      • Special investigation unit (SIU) personnel
      • In-house counsel
      • Third-party administrators
  • Describe the following interpersonal skills that claim representatives should possess and why they should possess them:
      • Managing customer expectations
      • Communicating effectively
      • Projecting empathy and establishing rapport
      • Resolving conflicts
      • Providing exceptional customer service
  • Describe the following types of laws, court systems, and forms of dispute resolution:
      • Criminal
      • Civil
      • Common statutory
      • Court systems and administrative law
      • State and federal court systems
      • Negotiation, arbitration/mediation, and lawsuits
  • Describe the state and federal laws that influence claim handling practices.
  • Explain how claim-practice regulations focus on complaints and unfair claim settlement practices.
  • Describe the areas on which good-faith claim handling practices should focus.
  • Explain how the following measures are used to ensure regulatory compliance:
      • Claim guidelines
      • Policies and procedures
      • Controls
      • Supervisor and manager reviews
      • Claim audits
Cost: $20 per Professional Development Hour (PDH). Information on PDHs provided can be found here.

Claim Handling Fundamentals Topics Include:

  • The parties to insurance policies, the roles those parties play, and others who� might benefit from the policies
  • Activities in the claim handling process
  • Roles of specific claim personnel and others who help handle claims
  • Interpersonal skills that claim representatives should possess and why they should possess them
  • Court systems and forms of dispute resolution
  • State and federal laws that influence claim handling practices
  • How claim-practice regulations focus on complaints and unfair claim settlement practices
  • Areas on which good-faith claim handling practices should focus
  • Measures used to ensure regulatory compliance
Phone: (800) 644-2101 (U.S. and Canada)
(610) 644-2100 (Outside the U.S. and Canada)
Fax: (610) 640-9576
Mail: The Institutes
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Suite 100
Malvern, PA 19355-3433
Customer Success is available Monday through Friday, 8 a.m. to 6 p.m. eastern time.

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E-mail: CustomerSuccess@TheInstitutes.org
Phone: (800) 644-2101

Customer Service hours are Monday through Friday, 8:00 a.m. to 6:00 p.m. eastern time.

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