About Claims Resolution
Claims resolution refers to processing and resolution of claims made against insurance. In the context of a natural disaster, for example, there might be facilities to process claims based upon insurance policies.
Claims resolution is a process with following steps
• Claim reporting
• Claim investigation
• Claim evaluation (including claim reserving and valuation)
• Claim resolution and settlement
There are many different steps involved while filing a claim on a term insurance plan. In case of unfortunate death of the insurance holder, the dependents (family members) or beneficiary under the term insurance policy should inform the insurer as soon as possible. In order to support the claim filed, it is necessary to submit all the required documents. However, prior to intimating the insurance company, the beneficiary should keep in mind some important facts.
• The insurance policy should be in force and all the premiums should be paid dully.
• The specific situation for which the claim is filed should be covered under the term insurance.
• Policy exclusion.
Why is Claims Resolution important?
Claims resolution is important for insurance companies as it helps build their brand and provide assurance to the insurance holder. The process forms an important function for insurance sector in completing the claim settlement to the satisfaction of the insurance company and insurance holder.
Claims resolution verifies the insurance holder’s claim and gives single interface to the insurance holder for any query thus, easing customer’s anxiety and fulfilling requirements to the satisfaction of the insurance holder.
Effective claims resolution helps in reducing insurance disputes or litigation from the insurance holder. It also detects and prevents insurance frauds.
Who should take the Claims Resolution Exam?
• Insurance and finance professionals
• Anyone who wants to assess their insurance and claims related skills
• Students
• Insurance and finance managers
• Insurance consultants and professionals working in outsourced companies engaged in insurance.
Claims Resolution Exam Objectives
Claims Resolution exam judges your skills in resolving insurance claims and application of legally prescribed process.
Claims Resolution Exam Prerequisite
There are no prerequisites for claim resolution exam.
Claims Resolution Certification Course Outline
1. Insurance
1.1 History
1.2 Principles of Insurance
1.3 Disclosure
1.4 Material Facts
1.5 Methods of insurance
1.6 Insurer’s Business Model
1.7 Types of Insurance
1.8 Insurance Policy
2. Underwriting
2.1 Introduction
2.2 Types of Underwriting
2.3 Underwriting Policy
2.4 Sources of Underwriting Information
2.5 Classes of Business
2.6 Assessment & Management of Exposure
2.7 Perils & Clause of Insurance Policies
2.8 Operational Control
2.9 Underwriting of Life Insurance
2.10 Underwriting of General Insurance
3. Underwriting and Claims Settlement
3.1 Introduction
3.2 Nature of Claim for Various Classes of Insurance
3.3 Types of Claims
3.4 Claim Settlement & Its Significance
3.5 Dispute, Litigation & Arbitration
4. Insurance Intermediaries
4.1 Introduction
4.2 The Role of Insurance Intermediaries
5. Claim Settlement
5.1 General Claim Settlement Procedure
5.2 Investigation and Assessment
5.3 Claims Documents
5.4 Arbitration
5.5 Settlement
5.6 Survey by Professional Surveyors
5.7 The Surveyor Report
5.8 Claim Procedure for Motor Insurance
5.9 Claim Procedure for Fire and Marine Insurance
5.10 Health Insurance Claim Settlement
5.11 Settlement of Insurance Claims
Exam Format and Information
Certification name – Claims Resolution Certification
Exam duration – 60 minutes
Exam type - Multiple Choice Questions
Eligibility / pre-requisite - None
Exam language - English
Exam format - Online
Passing score - 25
Exam Fees - INR 1199
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