Claims Course

Lesson 1 • Stakeholders in the Claims Process

Identifies insurers, adjusters, policyholders, claimants, and third parties. Clarifies each party's rights, obligations, and communication channels.

Lesson 2 • Regulatory and Ethical Framework

Introduces fair claims handling standards, licensing requirements, and ethical obligations. Sets the compliance baseline for all subsequent course content.

Lesson 3 • Policy Structure and Key Provisions

Examines declarations, insuring agreements, exclusions, and conditions. Students can locate and interpret critical policy language relevant to claims.

Lesson 4 • Insurance Principles and Risk Basics

Covers indemnity, insurable interest, subrogation, and utmost good faith. Establishes the conceptual framework underlying every claim decision.

Lesson 1 • Claim Closure and Documentation

Covers settlement authority, closure checklists, and file retention standards. Complete documentation protects the insurer and supports audit readiness.

Lesson 2 • Coverage Analysis and Verification

Teaches policy matching, effective date confirmation, and exclusion screening. Students apply policy interpretation skills to determine coverage applicability.

Lesson 3 • Reserving and Financial Tracking

Explains reserve setting principles, adequacy reviews, and financial controls. Proper reserving ensures accurate financial reporting and claim budget management.

Lesson 4 • First Notice of Loss Procedures

Covers intake channels, required data collection, and acknowledgment timelines. Accurate FNOL sets the foundation for efficient claim resolution.

Lesson 1 • Additional Living Expense and Business Income

Covers ALE and business income coverage triggers, documentation, and limits. Students calculate and manage these time-sensitive benefits accurately.

Lesson 2 • Damage Assessment Techniques

Covers visual inspection, measurement, and scope-writing for property losses. Students produce accurate damage scopes that support fair settlements.

Lesson 3 • Cause and Origin Determination

Teaches methods for identifying how and where a loss began. Accurate cause determination drives coverage decisions and fraud screening.

Lesson 4 • Valuation Methods for Property

Explains actual cash value, replacement cost value, and agreed value approaches. Selecting the correct method ensures indemnity-compliant settlements.

Lesson 1 • Liability Determination and Reporting

Guides students through fault allocation, coverage position letters, and liability reports. Clear documentation supports defensible claim decisions.

Lesson 2 • Witness and Statement Management

Teaches recorded statement techniques, witness identification, and statement analysis. Quality statements are critical evidence in contested liability claims.

Lesson 3 • Property Damage Liability Assessment

Addresses third-party property damage valuation, repair versus total loss, and diminished value. Accurate assessment prevents over- and underpayment.

Lesson 4 • Bodily Injury Evaluation

Covers injury documentation, medical record review, and damages calculation. Students assess special and general damages to determine fair settlement ranges.

Lesson 1 • Valuation Tools and Software

Introduces estimating platforms, medical bill review tools, and comparable sales databases. Proficiency with these tools improves speed and consistency of valuations.

Lesson 2 • Alternative Dispute Resolution

Covers mediation, arbitration, and appraisal processes as settlement alternatives. Students select the appropriate ADR method based on claim type and dispute nature.

Lesson 3 • Settlement Authority and Approval

Explains authority tiers, escalation protocols, and approval documentation. Understanding authority structures prevents unauthorized settlements and delays.

Lesson 4 • Negotiation Principles and Tactics

Teaches interest-based negotiation, anchoring, and concession strategies for claims. Effective negotiation reduces litigation exposure and improves closure rates.

Lesson 1 • Fraud Typology and Red Flags

Surveys hard fraud, soft fraud, and organized schemes across claim types. Recognizing patterns early enables timely investigation and loss prevention.

Lesson 2 • Fraud Analytics and Predictive Scoring

Explains scoring models, anomaly detection, and data-driven fraud triage. Analytics tools allow adjusters to prioritize high-risk claims efficiently.

Lesson 3 • Fraud Prevention and Culture

Addresses deterrence strategies, anti-fraud training, and organizational culture. Prevention reduces claim leakage and supports long-term financial performance.

Lesson 4 • Special Investigations Unit Referrals

Covers referral criteria, SIU intake procedures, and adjuster responsibilities. Timely and accurate referrals maximize fraud recovery and regulatory compliance.

Lesson 1 • Catastrophe Claims Management

Covers CAT event response, surge staffing, and triage protocols. Effective CAT management minimizes cycle time and policyholder hardship during disasters.

Lesson 2 • Commercial and Inland Marine Claims

Examines commercial property, equipment breakdown, and inland marine exposures. Students apply specialized valuation and coverage analysis to business claims.

Lesson 3 • Workers Compensation Claims

Addresses compensability determination, medical management, and return-to-work programs. Students manage the full workers compensation claim lifecycle effectively.

Lesson 4 • Professional and Management Liability Claims

Covers errors and omissions, directors and officers, and cyber liability claims. Students navigate complex coverage triggers and multi-party liability scenarios.

Lesson 1 • Litigation Management Strategy

Addresses defense counsel selection, litigation budgets, and early resolution strategies. Proactive litigation management reduces legal spend and adverse verdicts.

Lesson 2 • Strategic Planning for Claims Operations

Guides students through capacity planning, vendor strategy, and organizational design. Strategic alignment ensures claims operations support broader business objectives.

Lesson 3 • Key Performance Indicators in Claims

Defines cycle time, severity, frequency, and customer satisfaction metrics. Students use KPIs to diagnose operational gaps and set improvement targets.

Lesson 4 • Claims Audit and Quality Assurance

Covers file review protocols, scoring rubrics, and corrective action planning. Systematic audits ensure consistent compliance and technical accuracy across the team.