Course Outline

Module 1: Fundamentals of Insurance and Claims Handling

• Principles of insurance (indemnity, utmost good faith, insurable interest)
• Types of insurance and common claim triggers
• Claims lifecycle: notification, registration, assessment, settlement, closure
• Roles of insurers, reinsurers, brokers, and loss adjusters
• Case Study: Basic insurance claim handling workflow

Module 2: Reinsurance Concepts and Claims Management

• Introduction to reinsurance and its role in risk management
• Types of reinsurance (treaty vs facultative)
• Proportional and non-proportional reinsurance claims
• Reinsurance claims notification and documentation requirements
• Practical Exercise: Mapping insurer and reinsurer claim obligations

Module 3: Claims Assessment, Documentation, and Loss Evaluation

• Claims investigation and verification techniques
• Loss assessment methods and reserving practices
• Role of loss adjusters and surveyors
• Fraud indicators and claims leakage prevention
• Workshop: Reviewing and evaluating a complex claim file

Module 4: Claims Settlement, Recoveries, and Dispute Management

• Claims settlement methods and payment processes
• Reinsurance recoveries and cash call procedures
• Managing disputes, repudiations, and negotiated settlements
• Communication with cedants, brokers, and reinsurers
• Case Study: Disputed claim resolution and recovery strategy

Module 5: Regulatory Compliance, Reporting, and Best Practices

• Regulatory and legal considerations in claims handling
• Claims reporting, bordereaux, and data quality requirements
• Internal controls, audit trails, and governance in claims management
• Claims performance metrics and continuous improvement
• Practical Exercise: Developing a claims best-practice action plan