Insurance Premium and Claims Auditing Training Course

Course overview

Premium leakage, inaccurate earned-premium calculations, duplicate claim payments, weak reserving evidence, and inconsistent authority controls can materially affect an insurer’s loss ratio, financial reporting, and regulatory position. Audit teams need more than a checklist: they must be able to trace policy and claim transactions through underwriting, billing, collections, claims handling, reinsurance, and the general ledger, then distinguish isolated errors from systemic control failures. This course equips participants to plan and perform focused audits of premium and claims processes using evidence that stands up to management, external audit, and regulatory scrutiny.

Participants examine the full premium-to-cash and claim-to-payment lifecycle, including policy issuance and endorsements, rating and underwriting authority, premium receivables, earned and unearned premium, claims registration, adjuster authority, reserve movements, settlement controls, recoveries, salvage, and reinsurance. They learn to build risk-and-control matrices, define audit populations, select samples, test key controls, perform exception analysis, reconcile operational data to finance records, and quantify the financial impact of audit findings. Practical work uses spreadsheet analytics, audit queries, dashboards, and structured working papers.

The five-day programme is delivered through instructor-led technical sessions, insurer-based case studies, control-testing workshops, and hands-on data analysis. Participants work with simulated policy, billing, claims, payment, reserve, and ledger extracts to investigate premium and claims anomalies. They leave with a completed premium and claims audit pack: a risk assessment, audit programme, control test templates, exception log, quantified findings, and a management-ready audit report outline that can be adapted to their organisation.

The course is designed for insurance internal auditors, finance and compliance professionals, claims and underwriting control staff, and managers responsible for assurance over underwriting and claims operations. It is particularly valuable for teams preparing annual audit plans, responding to control incidents, strengthening first-line monitoring, or reviewing the financial integrity of insurance transactions.

Course objectives

By the end of this course, participants will be able to:

• Map premium-to-cash and claim-to-payment process flows, including hand-offs to reinsurance and the general ledger
• Build a risk-and-control matrix for underwriting, billing, claims, reserve, payment, and recovery activities
• Design an audit programme that defines objectives, populations, samples, evidence requirements, and control tests
• Test premium rating, endorsement, cancellation, receivable, and earned-premium controls using transaction evidence
• Analyse claims data for duplicate payments, authority breaches, reserve anomalies, delayed closures, and recovery leakage
• Reconcile policy administration and claims system extracts to premium, claims expense, reserve, and ledger balances
• Quantify the financial exposure of control exceptions using Excel-based exception analysis and sampling results
• Draft evidence-based audit findings, root-cause statements, recommendations, and management action plans

Benefits of attending

Target competencies

Who should attend

• Insurance Internal Auditors — who must test underwriting, premium, claims, and payment controls with defensible evidence
• Claims Audit Managers — who need to identify payment leakage, authority breaches, reserve weaknesses, and recovery gaps
• Insurance Finance Managers — who reconcile operational transactions to premium, claims, reserve, and ledger reporting
• Underwriting Governance Managers — who oversee rating, delegated authority, endorsements, and premium-control compliance
• Risk and Compliance Officers — who monitor operational-control failures and regulatory exposure across insurance processes
• External Audit and Assurance Professionals — who review insurance revenue, claims liabilities, and supporting control environments

Requirements and prerequisites

Participants should understand basic insurance terminology, including policy, premium, endorsement, claim, reserve, deductible, subrogation, salvage, reinsurance, and general ledger. Experience in internal audit, claims operations, underwriting, finance, compliance, or insurance controls is expected; participants should be comfortable reading process narratives and working with transaction-level data in Microsoft Excel, including filters, formulas, and pivot tables. Prior exposure to audit planning, sampling, or control testing is useful but not mandatory. No programming, actuarial qualification, specialist fraud-investigation credential, or prior use of ACL Analytics or Power BI is required.

Training methodology

Instructor-led sessions establish the insurance control framework and demonstrate each audit method before participants apply it. Using simulated policy, premium, claims, payment, reserve, recovery, and general-ledger data, participants construct audit populations in Excel, investigate exceptions, and document evidence in working-paper templates. Small groups audit a fictional insurer’s premium and claims processes, challenge control design, and present findings to a mock audit committee. Each participant concludes by adapting the course audit pack into a practical application plan for a current or planned review.

Course outline

Day 1: Insurance audit scope, risk and planning

• Insurance value chain from quotation to premium collection and claim settlement
• Premium, claims, reserve, recovery, and reinsurance data flows
• Audit universe development for underwriting, billing, claims, and finance operations
• Inherent-risk assessment using loss ratio, cancellation, receivable, and claims indicators
• Risk-and-control matrix design for insurance operational processes
• Audit objectives, criteria, materiality, and evidence requirements
• Population definition, sampling approaches, and audit trail documentation

Workshop: Participants create a risk assessment and risk-and-control matrix for a fictional motor insurer’s premium and claims operations.

Day 2: Auditing premium and underwriting controls

• Underwriting authority matrices and delegated authority testing
• Rating engine, manual override, discount, and referral controls
• Policy issuance, endorsement, renewal, lapse, and cancellation audit trails
• Premium billing, collection, refund, credit-note, and suspense-account controls
• Gross written premium, unearned premium, and earned-premium reconciliation methods
• Premium receivables ageing and bad-debt control testing
• Premium leakage analytics using duplicate, missing, outlier, and threshold tests

Workshop: Participants analyse a policy and billing extract to identify rating overrides, missing collections, duplicate refunds, and earned-premium reconciliation breaks.

Day 3: Auditing claims, reserves and payments

• Claim notification, coverage validation, and policy linkage controls
• Claims authority limits, segregation of duties, and adjuster approval testing
• Case reserve establishment, reserve changes, and closure control testing
• Claims payment validation, duplicate-payment detection, and bank-detail controls
• Settlement documentation, litigation files, and exception escalation evidence
• Salvage, subrogation, contribution, and third-party recovery controls
• Claims leakage indicators across frequency, severity, duration, and settlement patterns

Workshop: Participants test a claims-payment population, document exceptions, and quantify the exposure from duplicate payments, authority breaches, and unsupported settlements.

Day 4: Data analytics and financial reconciliation

• Preparing policy and claims extracts for audit analysis
• Excel pivot tables, XLOOKUP, conditional logic, and duplicate matching for audit tests
• ACL Analytics procedures for stratification, gaps, duplicates, and joins
• Power BI exception dashboards for premium and claims risk indicators
• Reconciliation of policy, claims, payment, reserve, and general-ledger balances
• Trend, ratio, and variance analysis for loss ratios and reserve movements
• Exception validation, false-positive resolution, and evidence retention

Workshop: Participants build an exception analysis workbook and dashboard that reconciles operational extracts to ledger balances and prioritises items for investigation.

Day 5: Reporting findings and driving remediation

• Evaluating control design versus operating effectiveness
• Root-cause analysis using five-whys and control-failure categorisation
• Financial impact calculation for premium and claims audit exceptions
• Writing condition, criterion, cause, consequence, and recommendation statements
• Rating findings by risk, materiality, recurrence, and regulatory exposure
• Management action plans, ownership, due dates, and follow-up testing
• Audit committee reporting and communication of insurance control themes

Workshop: Participants complete and present a management-ready audit report covering premium and claims findings, quantified exposure, root causes, and corrective actions.

Tools & standards covered

Microsoft Excel, Diligent ACL Analytics, Microsoft Power BI, ISO 19011:2018

A typical training day

Live online deliveries follow the same structure in the East Africa Time zone, with shorter screen blocks and longer breaks.

What the fee includes

How you can take this course

Certification

Participants who complete the full five days receive the Skillset Development Certificate of Completion, stating the course title, course code, dates and delivery format — suitable for professional-development records and employer reimbursement.

Frequently asked questions