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Why you need this course:
To properly handle claims, claim representatives must know how to apply information about the claim and the insurance policy in a systematic process that reinforces good claim handling practices. Factors that affect the claim environment influence claim-handling practices.
Upon successful completion of all nine modules in this course, you should be able to:
- Describe the parties to, the roles the parties play, and who else might benefit from insurance 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, and 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; and negotiation, arbitration/mediation, and lawsuit.
- 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; and claim audits.
Modules can be studied in any order you choose.
Contact Customer Service.
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