EFFECTIVE INSURANCE CLAIMS HANDLING – MASTERCLASS
Mastering Claims Processes, Fraud Prevention & Client Communication for Optimal Outcomes
Course Schedule
| Date | Venue | Fees (Face-to-Face) |
|---|---|---|
| 01 – 05 Dec 2025 | Kuala Lumpur, Malaysia | USD 3495 per delegate |
Course Introduction
The claims function is the true moment of truth in the insurance value chain—when clients measure the quality of service promised. Effective claims handling requires deep knowledge of policy coverage, legal procedures, negotiation skills, and proactive communication to resolve claims efficiently and equitably.
This intensive 5-day masterclass is designed to develop advanced competencies in managing complex insurance claims across life, health, property, liability, and commercial lines. Participants will gain tools to minimize disputes, detect fraud, optimize turnaround times, and maintain high customer satisfaction throughout the claims lifecycle.
Course Objectives
By the end of this course, participants will be able to:
• Interpret insurance policies and coverage clauses with precision
• Manage end-to-end claims processes from notification to settlement
• Assess losses accurately and manage adjusters and third-party providers
• Prevent and detect fraudulent claims through investigation techniques
• Enhance customer experience and regulatory compliance in claims handling
Key Benefits of Attending
• To improve operational efficiency in claims processing
• To build credibility and trust with policyholders during critical interactions
• To reduce exposure to legal and reputational risks
• To identify and combat fraud effectively
• To ensure regulatory and policyholder rights are consistently upheld
Intended Audience
This program is designed for:
• Insurance claims officers, adjusters, and underwriters
• Risk and loss management professionals
• Insurance brokers and client service executives
• Legal advisors and compliance officers in the insurance sector
• Anyone involved in managing or supervising the claims function
Individual Benefits
Key competencies that will be developed include:
• Deep understanding of claims policy terms and exclusions
• Efficient handling of routine and complex claims
• Stakeholder negotiation and settlement skills
• Legal awareness in liability, indemnity, and dispute resolution
• Fraud detection and investigative methods
Organization Benefits
Upon completing the training course, participants will demonstrate:
• Faster claims resolution with improved accuracy and customer service
• Enhanced regulatory compliance and documentation control
• Reduced financial leakage through fraud prevention and cost control
• Strengthened brand reputation through professional claim handling
• Clearer roles and collaboration between claims, legal, and underwriting
Instructional Methdology
The course follows a blended learning approach combining theory with practice:
• Strategy Briefings – Global insurance trends, legal context, and claims frameworks
• Case Studies – Real-life claims scenarios in life, property, and casualty lines
• Workshops – Claims file assessment, fraud red flag identification, and customer interaction planning
• Peer Exchange – Group discussions on handling disputed and high-value claims
• Tools – Claims checklists, fraud risk indicators, settlement templates, and communication scripts
Course Outline
Detailed 5-Day Course Outline
Training Hours: 7:30 AM – 3:30 PM
Daily Format: 3–4 Learning Modules | Coffee breaks: 09:30 & 11:15 | Lunch Buffet: 01:00 – 02:00
Day 1: Fundamentals of Claims Management
- Module 1: The Claims Lifecycle – Overview and Objectives (07:30 – 09:30)
• Notification, assessment, processing, settlement, and closure
• Stakeholders and their responsibilities - Module 2: Policy Interpretation and Coverage Analysis (09:45 – 11:15)
• Understanding policy wording, exclusions, and endorsements
• Limits of liability and coverage applicability - Module 3: Workshop – Reviewing a Complex Claims Scenario (11:30 – 01:00)
• Hands-on interpretation of a multi-line insurance policy - Module 4: Customer Service and Communication in Claims (02:00 – 03:30)
• Managing expectations and delivering empathetic service
Day 2: Claims Investigation and Adjustment
- Module 5: Gathering Evidence and Documentation (07:30 – 09:30)
• Required documentation and interviews
• Importance of timeliness and record-keeping - Module 6: Claims Adjustment Process (09:45 – 11:15)
• Role of loss adjusters and third-party providers
• Cost evaluation and settlement calculation - Module 7: Workshop – Drafting a Claims Adjustment Report (11:30 – 01:00)
• Sample claims analysis and resolution proposal - Module 8: Legal and Regulatory Considerations (02:00 – 03:30)
• Local compliance, consumer rights, and insurer obligations
Day 3: Specialized Claims and Dispute Management
- Module 9: Handling Property, Liability, and Motor Claims (07:30 – 09:30)
• Specific challenges in high-frequency lines - Module 10: Managing Complex and High-Value Claims (09:45 – 11:15)
• Coordination across legal, technical, and financial teams - Module 11: Workshop – Disputed Claims Mediation Role-Play (11:30 – 01:00)
• Simulating a claim dispute with negotiation and resolution - Module 12: Reinsurance and Claims Escalation (02:00 – 03:30)
• Excess claims and reinsurance considerations
Day 4: Fraud Detection and Risk Mitigation
- Module 13: Understanding Insurance Fraud (07:30 – 09:30)
• Fraud types: staged, inflated, misrepresentation, and organized - Module 14: Fraud Indicators and Investigative Techniques (09:45 – 11:15)
• Red flags, claim profiling, and digital tracking - Module 15: Workshop – Building a Fraud Response Plan (11:30 – 01:00)
• Creating SOPs for suspected fraud claims - Module 16: Collaboration with Legal and Law Enforcement (02:00 – 03:30)
• Escalation process, case files, and court coordination
Day 5: Best Practices, Technology, and Continuous Improvement
- Module 17: Claims Process Optimization and KPIs (07:30 – 09:30)
• Turnaround time, accuracy, customer satisfaction, and cost control - Module 18: Technology in Claims – AI, Automation, and Portals (09:45 – 11:15)
• InsurTech applications and workflow enhancements - Module 19: Workshop – Designing a Claims Excellence Framework (11:30 – 01:00)
• Process mapping and performance metrics - Module 20: Final Review and Certification (02:00 – 03:30)
• Group reflection, feedback, and individual action plans
Certification
Participants will receive a Certificate of Completion in Effective Insurance Claims Handling – Masterclass, validating their professional capability to manage claims with legal, operational, and customer-centric excellence.