Claims Management Training

Lesson 1 • What Is a Claim

Defines a claim, its legal basis, and its place in the insurance value chain. Establishes shared vocabulary used throughout the course.

Lesson 2 • Key Stakeholders and Their Roles

Identifies internal and external parties involved in a claim. Clarifies accountability and communication expectations for each role.

Lesson 3 • Regulatory and Ethical Framework

Introduces the compliance obligations and ethical standards governing claims handling. Sets the professional conduct baseline for the entire course.

Lesson 1 • Initial Coverage Verification

Teaches how to confirm policy existence, effective dates, and applicable coverages at intake. Early verification reduces misdirected claim effort.

Lesson 2 • Claimant Communication at Intake

Establishes protocols for the first interaction with claimants, including tone, disclosures, and timeline commitments. Builds trust from the first contact.

Lesson 3 • Claim Assignment and Prioritization

Explains how claims are routed to the right adjuster based on complexity, line of business, and urgency. Proper assignment drives efficiency.

Lesson 1 • Recorded Statements and Interviews

Teaches structured interviewing of claimants, witnesses, and third parties. Effective statements surface facts that documents alone cannot reveal.

Lesson 2 • Evidence Collection and Preservation

Covers physical, digital, and documentary evidence gathering with chain-of-custody standards. Proper preservation protects evidentiary value.

Lesson 3 • Using Expert Resources

Explains when and how to engage engineers, medical professionals, and other specialists. Expert input strengthens technical findings.

Lesson 4 • Documenting Investigation Findings

Establishes standards for compiling investigation results into a clear, auditable record. Strong documentation supports every subsequent decision.

Lesson 1 • Denials and Partial Payments

Covers the process for issuing full or partial denials with proper notice and reasoning. Compliant denial letters reduce regulatory and legal exposure.

Lesson 2 • Handling Coverage Disputes

Addresses situations where coverage is contested by the claimant or policyholder. Dispute protocols protect both parties and reduce litigation risk.

Lesson 3 • Applying Coverage to Claim Facts

Teaches a step-by-step method for matching investigated facts to policy provisions. Structured analysis produces consistent, defensible outcomes.

Lesson 1 • Liability Exposure Assessment

Explains how to evaluate fault, comparative negligence, and total exposure in liability claims. Exposure analysis drives reserve accuracy.

Lesson 2 • Reserving Principles and Practices

Connects valuation findings to setting and adjusting claim reserves. Accurate reserves protect financial solvency and regulatory compliance.

Lesson 3 • Property Damage Assessment

Covers inspection, scoping, and pricing of structural and personal property losses. Accurate scoping prevents underpayment and overpayment.

Lesson 4 • Bodily Injury Valuation

Teaches evaluation of medical expenses, lost wages, and general damages in injury claims. Objective valuation reduces settlement disputes.

Lesson 1 • Special Investigations Unit Referrals

Explains when and how to escalate suspected fraud to a Special Investigations Unit (SIU). Proper referrals ensure expert handling and legal compliance.

Lesson 2 • Red Flags and Indicators

Teaches recognition of behavioral, documentary, and circumstantial fraud indicators. Early identification limits fraud-related losses.

Lesson 3 • Fraud Investigation Methods

Covers surveillance, database searches, and social media analysis used in fraud investigations. Methodical investigation builds defensible fraud findings.

Lesson 4 • Fraud Prevention and Culture

Addresses organizational controls and staff training that reduce fraud vulnerability. Prevention reduces the volume of fraudulent claims entering the system.

Lesson 1 • Structured Settlement Options

Explains lump-sum, structured, and annuity payment arrangements and their appropriate use. Matching payment structure to claimant needs improves acceptance.

Lesson 2 • Negotiation Techniques for Adjusters

Covers principled negotiation tactics adapted for the claims context. Effective technique reduces adversarial escalation and litigation.

Lesson 3 • Releases and Closing Documentation

Covers the legal instruments that finalize a settlement and close the claim file. Proper releases prevent future reopening of resolved claims.

Lesson 1 • Managing Complex and High-Value Claims

Covers the additional oversight, coordination, and strategy required for large or complex losses. Senior-level handling protects financial and reputational interests.

Lesson 2 • Coaching and Developing Adjusters

Provides frameworks for supervising, coaching, and evaluating adjuster performance. Effective development builds a high-performing claims team.

Lesson 3 • Strategic Alignment and Stakeholder Reporting

Connects claims outcomes to broader organizational strategy and communicates results to leadership. Strategic alignment ensures claims supports business objectives.

Lesson 4 • Claims Performance Metrics

Introduces key performance indicators used to measure claims efficiency, accuracy, and customer satisfaction. Metrics enable data-driven management decisions.