Introduction
The programme “Preparing Professional Claims Managers” develops professional practice in Insurance and Compensation. It connects the subject with workplace challenges by examining existing evidence and practices and choosing methods appropriate to the organization and its available resources.
The learning progresses from claims, dispute, and evidence management to financial statement and report analysis, with practical work on leadership and team direction, insurance, claims, and compensation management, risk assessment, controls, and response. Participants prepare outputs to support workplace application and review the quality and results of implementation.
Learning objectives
- Prepare a documented claim connecting its basis, facts, effects, and supporting documents in an application related to “Preparing Professional Claims Managers”.
- Identify leadership practices suited to the situation and allocate responsibilities clearly.
- Analyze insurance coverage and a claim process, and document the settlement basis.
- Prepare a risk register connecting causes, consequences, controls, and treatment responsibilities.
- Interpret performance, financial position, and cash flows using documented analysis with clear limitations.
Learning areas
1. Claims, Dispute, and Evidence Management
- Analyze the event giving rise to the claim, notice requirements, jurisdiction, and deadlines by referring to the contract and applicable law.
- Prepare a chronology connecting correspondence, instructions, and execution records, distinguishing facts, estimates, and allegations.
- Identify the relationship between the event and its time or financial effects, examining alternative explanations and the data needed to establish causation.
- Draft a claim file explaining the request, its basis, supporting documents, and calculation method, and review consistency and weaknesses before submission.
- Compare negotiation, settlement, and escalation routes according to authority, cost, and time, and prepare a register of lessons and measures to prevent recurring disputes. The application examines a case related to “Preparing Professional Claims Managers”.
2. Leadership and Team Direction
- Analyze the leadership situation in terms of the task, the team's experience, and the constraints affecting the decision, and select an appropriate approach to direction.
- Distinguish the leader's responsibility for results from team members' responsibility for delivery, and define performance expectations that can be monitored.
- Apply delegation by specifying the task, authority, resources, and review checkpoints, and address overlapping team responsibilities.
- Conduct a leadership conversation that includes listening, questioning, and specific feedback linked to behavior and results.
- Address a practical situation requiring a choice between leadership approaches, and document the reasons for the choice and how its effects will be monitored.
3. Insurance, Claims, and Compensation Management
- Read an insurance policy and identify the risk, coverage, limits, exclusions, deductible, and parties, referring to applicable terms and rules.
- Define claim documents, notices, deadlines, and handling procedures, and organize incident data without presuming coverage applies.
- Analyze the relationship between the event, loss, evidence, and estimates, distinguishing confirmed information from matters requiring expertise or further verification.
- Review compensation valuation alternatives, settlement bases, and approval authority, documenting calculations, decision rationale, and available appeal procedures.
- Set indicators for processing time, file accuracy, complaints, and suspicious activity, and improve controls and communication with the claimant during follow-up.
4. Risk Assessment, Controls, and Response
- Define the work context, objectives, and assessment boundaries, and distinguish the risk source, potential event, and effects on results.
- Gather risks from processes, data, past incidents, and interviews with responsible staff, and document causes and existing controls.
- Estimate likelihood and impact using stated criteria, and review control effectiveness to determine residual risk levels.
- Select a response proportionate to the risks, resources, and authority, and specify the owner, deadline, and early warning indicator.
- Test a scenario involving changing circumstances, update the risk register, and present material risks and required decisions to the appropriate authority.
5. Financial Statement and Report Analysis
- Read the relationships between the statements of financial position, performance, and cash flows and the notes, identifying the effects of accounting policies and estimates.
- Perform horizontal and vertical analysis and compare profitability, liquidity, efficiency, and leverage indicators, considering the nature and size of the business.
- Examine earnings quality, cash flows, and nonrecurring items, and identify differences between accounting results and actual liquidity.
- Test the sensitivity of results to changes in sales, costs, collections, and financing, stating the assumptions and constraints in each scenario.
- Write a financial report linking indicators to management's question and available alternatives, presenting risks and additional data needed for the decision.
Practical outputs
- A claim file, chronology, document matrix, and impact analysis.
- A map of leadership roles and a mechanism for team delegation and follow-up.
- An insurance claim file, coverage matrix, and settlement tracking template.
- A risk register, control matrix, and prioritized treatment plan.
- A comparative financial analysis report and a memo of findings and assumptions.
Who should attend
- Practitioners, specialists and supervisors whose work relates to the programme subject.
- Managers and teams working in insurance and compensation, according to their practical responsibilities.
- Professionals responsible for applying the outputs of “Preparing Professional Claims Managers” within their organizations.
Prerequisites
- Working familiarity with the programme field and the ability to discuss a professional case or challenge.
- Confirm the suitability of your experience and any specialist prerequisites with the Union before participation.
Conclusion
The programme “Preparing Professional Claims Managers” brings together concepts, case review and a practical application. Participants prepare steps that can be adapted to their responsibilities and organizational resources, with an indicator to follow application and review results after returning to work.
Participation arrangements and any special requests are specified in the confirmation issued by the Union.