Introduction
The programme “Regulatory Compliance in Insurance” 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 insurance, claims, and compensation management to claims, dispute, and evidence management, with practical work on governance, accountability, and compliance management, procedure analysis and work simplification, risk assessment, controls, and response. Participants prepare outputs to support workplace application and review the quality and results of implementation.
Learning objectives
- Analyze insurance coverage and a claim process, and document the settlement basis in an application related to “Regulatory Compliance in Insurance”.
- Define decision-making authority, accountability mechanisms, and obligation monitoring.
- Redesign a procedure to reduce delays and rework while maintaining controls.
- Prepare a risk register connecting causes, consequences, controls, and treatment responsibilities.
- Prepare a documented claim connecting its basis, facts, effects, and supporting documents.
Learning areas
1. 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. The application examines a case related to “Regulatory Compliance in Insurance”.
2. Governance, Accountability, and Compliance Management
- Map decision-making, oversight, and execution levels, and identify separation of roles and potential conflicts of interest.
- Review policies, committees, delegated authorities, and reporting frequency, and connect each responsibility to clear authority and limits.
- Create an obligations register specifying the source, scope, responsible party, and compliance evidence, and review applicable local requirements.
- Define disclosure, accountability, complaint handling, and misconduct reporting mechanisms, and protect information confidentiality during follow-up.
- Assess a practical governance case and prepare a gap remediation plan with review indicators and evidence of action closure.
3. Procedure Analysis and Work Simplification
- Define the procedure's start, end, owner, inputs, and outputs, and collect data on processing time, waiting, and rework.
- Map the actual workflow between roles, identifying approvals, handovers, bottlenecks, and duplicate data entry.
- Analyze the value added by each step and the controls it provides, and propose combining, removing, or running steps in parallel with reasons for the choice.
- Document the improved procedure with clear authorities, forms, timelines, and standards, and review its effects on beneficiaries and delivery teams.
- Test the procedure on a limited case, measure time, errors, and output quality, and document adjustments and the rollout plan.
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. 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.
Practical outputs
- An insurance claim file, coverage matrix, and settlement tracking template.
- An authority matrix, obligations register, and escalation and review mechanism.
- An improved procedure map, service profile, and acceptance criteria for implementation.
- A risk register, control matrix, and prioritized treatment plan.
- A claim file, chronology, document matrix, and impact analysis.
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 “Regulatory Compliance in Insurance” 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 “Regulatory Compliance in Insurance” 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.