Claims Processing

Catalog description

This course provides an in-depth analysis of claims processing, including claims intake, member and provider verification, claims adjudication, and claims payment processes; the use of automation in claims processing; and the processes for minimizing fraud and errors. The claim handling process will be examined in detail, including the processes for investigating and documenting the claim and determining the cause of the loss, the liability, and the loss amount across specific categories of claims; bodily injury liability claims, property claims, workers compensation claims, medical claims, and auto claims. The importance of detecting and preventing insurance fraud, and effective communication and negotiation skills in the handling of clams will also be covered. Lastly, we will examine how technology and artificial intelligence is being used in the claims management process to increase the quality in claims assessment management and administration.