Introduction
The programme “Analyzing Performance Indicators in Claims Management” 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 performance measurement and continuous improvement, 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 “Analyzing Performance Indicators in Claims Management”.
- Build performance indicators that distinguish activity completion from achievement of results.
- 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 “Analyzing Performance Indicators in Claims Management”.
2. Performance Measurement and Continuous Improvement
- Define the intended result and its beneficiary, and distinguish indicators of inputs, activities, outputs, and impact.
- Define each indicator's formula, unit of measurement, data source, update frequency, and responsibility for collection and verification.
- Select a baseline, realistic target, and alert thresholds, and review data quality before interpreting deviations from the target.
- Analyze the causes of performance gaps and link them to corrective actions with specified owners, deadlines, resources, and closure verification methods.
- Design a review meeting covering trends, decisions, and open actions, and track improvement over more than one measurement cycle.
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.
- Performance indicator cards and a plan for reviewing results and improvement actions.
- 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 “Analyzing Performance Indicators in Claims Management” 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 “Analyzing Performance Indicators in Claims Management” 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.