Overview
Effective claims handling is central to maintaining trust between insurers and policyholders. This course provides practical knowledge of the principles and practices involved in managing insurance claims efficiently, fairly, and professionally.
Participants will develop a clear understanding of the claims process, documentation requirements, investigation procedures, and best practices for delivering timely and transparent claims service.
Through structured online modules, the programme equips professionals with the knowledge required to support effective claims administration and strengthen customer confidence in insurance services.
Who Should Enrol
This course is designed for professionals involved in insurance operations and claims management, including:
- Insurance claims officers
- Insurance agents and sales professionals
- Underwriting and operations staff
- Insurance brokers and intermediaries
- Branch managers and distribution leaders
- Professionals seeking to build foundational knowledge in claims handling
What You Will Learn
- The role and importance of claims handling in insurance operations
- The insurance claims process from notification to settlement
- Documentation and claims reporting requirements
- Claims investigation and verification procedures
- Fraud awareness and claims risk management
- Best practices for delivering efficient and customer-focused claims service
Learning Pathway
This course forms part of the IIEA E-Academy Learning Pathway Framework™ for Advanced Insurance Professionals, designed to strengthen technical expertise across key areas of insurance practice.
Certification
Participants who successfully complete the course requirements will receive a Certificate of Achievement issued by the Insurance Institute of East Africa (IIEA).
Learning Outcomes
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.
