Online course: LOMA 301 – Insurance Administration

Subjects

• Explain the importance of efficient administration practices to a company’s business processes, productivity, profitability, and compliance with regulatory and ethical standards.
• Describe how marketing, actuarial, accounting, treasury operations, legal, compliance, human resources, and information technology coordinate with staff in insurance administration, notably underwriting, claim administration, reinsurance, and customer service.
• Describe how governments in the United States and Canada regulate discrimination, privacy, medical testing, replacements, money laundering, and financing terrorists during the underwriting process for both individual and group business.
• Define key considerations, such as insurable interest, risk assessment and classification, suitability, information sources, and anti-selection that influence the decision to approve and issue insurance; how these determine whether coverage is preferred, standard, sub-standard, or declined; and if reinsurance may be necessary.
• List the basic features and underwriting considerations of various types of insurance, including multi-life policies, juvenile insurance policies, buy-sell agreements, key-person life insurance, split-dollar life insurance, creditor insurance, and direct response policies.
• Explain the importance of an insurer’s claim philosophy in guiding its claim practices, the steps it takes in evaluating a typical claim, and any “red flags” that indicate potentially fraudulent claims.
• Explain how claim analysts determine the proper payee for life insurance policy proceeds and describe situations involving the beneficiary, policy assignments, adverse claimants, community property laws, divorce, and simultaneous deaths that can complicate the payment process.
• Recognize actions that qualify as unfair claim practices according to the NAIC Unfair Claims Settlement Practices Act, and requirements imposed on insurers by the NAIC Unfair Life, Accident and Health Claims Settlement Practices Model Regulation.
• Describe how a database management system, data mining, predictive modeling, a business rules engine, a document management system, and an automated workflow system enhance insurance administration processes and reduce security risks.
• Identify the benefits to insurers of providing effective customer service including the typical ways that insurers organize customer service departments and the tools that automate and simplify customer service delivery.