STANDARD COMPETENCIES:

 

 I.      Explain the role of insurance in addressing financial losses and how the claims representative interacts with others involved in insurance.

 II.     Describe the claim process beginning with determining whether coverage exists for the loss to assessment to resolution of the claim.

 III.    Understand what motivates a person when filing a claim whether it¿s the claimant or the insured.

 IV.     Provide examples of communication styles and/or human relations that a claims representative may need to utilize.

 V.      Describe the Communication Process and effectively apply that knowledge to the various forms of communication¿written, verbal, email, etc.

 VI.     Explain the Negotiation Process and prepare an effective negotiation strategy.

 VII.    Describe Insurance Fraud, the implications of fraud, and how to combat fraud.

 VIII.   Understand the legal system as it applies to the claims process.

 IX.     Know the difference between criminal and civil law as applied to insurance claims.

 X       Describe the role of the claims representative, the insured, and the defense attorney.

 XI.     Define Insurance Bad Faith.

 XII.    List defenses to bad faith claims.

 XIII.   Describe how to promote good faith claims.

 XIV.    Define Claim Management and its objectives.

 XV.     List steps a claims representative may take to ensure professionalism, quality claims practices, and ethical behavior.

 TOPICAL OUTLINE:

 

 I.      Insurance and the Claims Representative¿s Role

 II.     The Claim Process

 III.    Human Relations in Claims

 IV.     Communication

 V.      Applications of Communication

 VI.     Negotiation

 VII.    Insurance Fraud

 VIII.   Law and the Legal System

 IX.     Bad Faith

 X       Defending Bad Faith Claims and Promoting Good Faith

 XI.     Claim Management

 XII.    Professionalism, Quality Claims Practices, and Ethics