Claims Management Training Course

Participants can capture complete first-notification information and route claims correctly.

• First notification of loss data requirements and contact verification
• Structured intake scripts capturing incident facts, urgency and customer needs
• Triage criteria based on severity, complexity, vulnerability and fraud indicators
• Case categorisation codes supporting workflow, reserves and management reporting
• Immediate customer actions, mitigation duties and emergency service arrangements
• Service-level clocks, acknowledgement requirements and missed deadline escalation

Participants can determine preliminary coverage or entitlement using contract terms and evidence.

• Policy schedule, insuring clause, exclusions and conditions read systematically
• Account terms, payment rules and dispute rights assessed for banking claims
• Coverage analysis worksheet linking facts, wording and provisional conclusions
• Proximate cause and material facts considered within applicable legal advice
• Reservation of rights letters separating unresolved issues from accepted elements
• Authority limits and referral triggers for unusual or high-value exposures

Participants can create proportionate investigation plans for different claim types.

• Investigation objectives derived from coverage questions, liability and quantum issues
• Evidence matrix mapping required facts, sources, owners and due dates
• Proportionate investigation scope matched to value, complexity and risk
• Document requests, photographs, records and digital evidence preservation
• Chain of custody records protecting evidence integrity and admissibility
• Investigation plan updates triggered by new facts or conflicting evidence

Participants can gather reliable statements and assess evidence quality.

• PEACE interview model for planned, ethical claimant and witness conversations
• Open and probing questions separating observations, assumptions and opinions
• Contemporaneous interview notes capturing dates, wording and material admissions
• Witness statements tested against documents, timelines and independent evidence
• Credibility assessment avoids unsupported assumptions and discriminatory reasoning
• Evidence weighting distinguishes verified facts, allegations and unresolved gaps

Participants can analyse liability, causation and shared responsibility within a claim file.

• Duty, breach, causation and damage assessed through claim facts
• Timeline analysis identifies decision points, actions and causal links
• Contributory negligence and shared responsibility documented using available evidence
• Liability investigation findings translated into defensible settlement positions
• Expert reports evaluated for scope, assumptions, limitations and contradictions
• Legal counsel referral criteria for disputed liability and novel issues

Participants can set, justify and review individual case reserves.

• Case reserve components include indemnity, expenses, fees and recoveries
• Initial reserve estimates based on exposure, probability and severity
• Best estimate assumptions documented with evidence, uncertainty and review dates
• Reserve movements explained through new information, settlement developments or inflation
• Authority controls separate reserve approval from payment authorisation duties
• Incurred but not reported concepts distinguished from individual case reserves

Participants can calculate and explain settlement values using documented assumptions.

• Loss quantification separates covered damage, uninsured items and deductions
• Repair-versus-replace analysis tests reasonable restoration cost and depreciation
• Policy limits, excesses, deductibles and co-insurance applied accurately
• Medical bills, invoices and payroll evidence validated before payment
• Settlement ranges developed from evidence, uncertainty and negotiation parameters
• Calculation schedules provide an auditable basis for payment recommendations

Participants can identify fraud indicators and make appropriate referrals.

• Fraud typologies include exaggeration, fabrication, staging and identity misuse
• Red flags assessed cumulatively rather than treated as proof
• Fraud referral packs document concerns, evidence, losses and recommended actions
• Data anomalies reveal duplicate claims, unusual patterns and linked parties
• Confidentiality controls protect investigations from improper disclosure or tipping-off
• Suspected fraud decisions preserve fair treatment and evidence-based reasoning

Participants can communicate claim decisions clearly while addressing customer needs.

• Plain-language communications explain decisions, evidence, next steps and timelines
• Vulnerable customer indicators prompt reasonable adjustments and careful escalation
• Expectation setting covers service milestones, documents and settlement dependencies
• Difficult conversations use empathy, boundaries and accurate decision explanations
• Decision letters distinguish acceptance, partial settlement, denial and reservation
• Communication logs preserve commitments, contact preferences and complaint indicators

Participants can manage complaints and disputes without weakening claim controls.

• Complaint definitions separate dissatisfaction from requests for claim information
• Root-cause analysis identifies process failures, communication gaps and recurring errors
• ISO 10002 principles inform complaint acknowledgement, investigation and resolution
• Settlement negotiation prepares interests, alternatives, authority and concession limits
• Mediation and ombudsman referral options considered before formal litigation
• Complaint outcomes feed policy, training and process improvement actions

Participants can control outsourced services and assess supplier claim performance.

• Panel management sets selection criteria, service standards and reporting requirements
• Loss adjusters, repairers and medical providers assigned through controlled processes
• Service-level agreements define turnaround, quality, cost and communication measures
• Supplier invoices validated against scope, rates, approvals and delivered work
• Conflict-of-interest declarations protect independence in supplier recommendations
• Supplier scorecards compare outcomes, leakage, customer feedback and compliance

Participants can identify and progress recovery opportunities before limitation risks arise.

• Subrogation rights assessed after payment, liability evidence and contractual review
• Recovery potential screened using responsible parties, assets and documentation
• Salvage controls preserve value, ownership records and disposal approvals
• Recovery files track demands, responses, negotiations, costs and receipts
• Limitation dates diarised with escalation for approaching deadlines
• Net recovery reporting separates gross receipts, expenses and transferred recoveries

Participants can conduct quality reviews that improve decision consistency and control compliance.

• File audit criteria test coverage, evidence, reserves, communication and approvals
• Sampling methods distinguish random selection from risk-based review populations
• Quality scores record defects, severity, root causes and corrective owners
• Peer review challenges assumptions before high-value or complex claim decisions
• Calibration sessions align handlers on wording interpretation and evidence thresholds
• Corrective action tracking verifies completion and recurring issue reduction

Participants can map claims controls, accountabilities and escalation arrangements.

• Three Lines Model assigns operational, oversight and assurance responsibilities
• Delegated authority matrices define approval limits and exception escalation
• Segregation of duties controls assessment, payment, supplier selection and review
• Conduct risk indicators identify unfair outcomes, delays and inconsistent treatment
• Record retention schedules preserve claim evidence, decisions and communications
• Control testing documents design effectiveness, operating evidence and remediation

Participants can design reports that support operational and financial claims decisions.

• Claims dashboards combine volume, cycle time, severity and closure measures
• Frequency and severity trends segmented by product, cause and customer group
• Reserve adequacy reporting compares estimates, payments and settlement outcomes
• Leakage analysis identifies avoidable indemnity, expense and recovery losses
• Aging reports highlight stalled files, overdue actions and escalation needs
• Management commentary explains drivers, risks, decisions and required actions

Participants can organise claims operations during high-volume or disruptive events.

• Surge planning estimates volumes, staffing needs and priority claim categories
• Event triage prioritises safety, vulnerable customers and severe financial hardship
• Temporary authority arrangements maintain control during rapid response periods
• Supplier capacity plans address assessors, repairers, call centres and payments
• Catastrophe communication templates provide accurate updates amid uncertain information
• Post-event reviews capture bottlenecks, losses, lessons and corrective actions

Participants can assess common banking transaction claims using evidence and account records.

• Unauthorised transaction claims assessed through authentication and account activity evidence
• Card chargeback workflows distinguish merchant disputes from fraud allegations
• Payment trace requests document sender, recipient, timing and confirmation records
• Account takeover indicators trigger containment, investigation and customer communication
• Loss allocation considers customer actions, controls and contractual responsibilities
• Dispute resolution letters explain findings, remedies, rights and escalation routes

Participants can prepare claims for legal escalation while maintaining settlement discipline.

• Litigation hold procedures preserve relevant records, messages and physical evidence
• Counsel instructions define facts, issues, documents, authority and desired advice
• Legal cost budgets monitored against milestones, exposure and settlement prospects
• Settlement authority papers present risks, ranges, rationale and recommended terms
• Without-prejudice communications handled according to legal and organisational guidance
• Post-settlement closure confirms releases, payments, reserves and recovery actions

Participants can build, review and present a complete claims handling pack for a complex case.

• Case intake summary captures facts, triage result, urgency and customer needs
• Coverage or entitlement analysis links terms, evidence and decision rationale
• Investigation plan assigns evidence requests, interviews, deadlines and owners
• Reserve and settlement worksheet quantifies exposure, assumptions and payment recommendation
• Fraud, complaint, recovery and escalation risks documented with controls
• Claims dashboard and closure plan present outcomes, actions and lessons