Course in Quality Standards in Claims Management
Online 300-hour course in quality standards in claims management. 6 modules covering ISO 9001 (quality management systems), ISO 10002 (complaints handling) and Guidewire ClaimCenter. Assigned tutor and open enrolment.
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What you will be able to do
Understand claims management as a service with measurable standards.
Apply quality models such as ISO 9001 and EFQM to the claims process.
Define technical quality controls over claim files and loss adjustments.
Manage complaints and grievances in accordance with ISO 10002 and sector regulations.
Measure customer satisfaction with reliable indicators.
Implement continuous improvement cycles and quality governance.
Develop an integrative project on a quality system in claims management.
Who it's for
- Claims quality manager looking to specialise in Quality Standards in Claims Management.
- Claims management process auditor looking to specialise in Quality Standards in Claims Management.
- Claims handling supervisor looking to specialise in Quality Standards in Claims Management.
- Continuous improvement analyst looking to specialise in Quality Standards in Claims Management.
- Quality management systems consultant looking to specialise in Quality Standards in Claims Management.
- Customer service coordinator looking to specialise in Quality Standards in Claims Management.
- Engineering or science graduates seeking to enter insurance companies.
What you'll work with
- ISO 9001 (quality management systems)
- ISO 10002 (complaints handling)
- ISO 10004 (monitoring and measuring customer satisfaction)
- ISO 18295-1 (customer contact centres)
- EFQM Model
- Order ECO/734/2004 (customer service in financial institutions)
- ISO 9004 (managing for sustained success)
6 modules · 300 h
1.1The claim as a moment of truth1.2Policyholder expectations and the reality of the process1.3Actors: claims handler, loss adjuster, garage and supplier1.4Types of claim and their routes1.5Classic indicators for the department1.6The tension between cost, time and satisfaction1.7Sector vocabulary and acronyms1.8The most common sources of dissatisfaction1.9Impact on portfolio retention1.10Exercise: mapping the process of a claim
2.1Applicable quality management standards2.2Customer satisfaction and complaints standards2.3Sector codes of good practice2.4Supervisory requirements on claims handling2.5Legal deadlines and their control2.6Internal and external service level agreements2.7Claims handling manual and consistent criteria2.8Process documentation2.9Certification of the management system2.10Practice: defining service level agreements
3.1Sample-based review of claim files3.2Technical quality criteria for the claim file3.3Consistency of assessment and criteria3.4Auditing loss adjusters and suppliers3.5Detecting systematic errors3.6Calibrating criteria across claims handlers3.7Knowledge management and reference cases3.8Ongoing training for the team3.9Technical quality indicators3.10Practice: a claim file checklist
4.1Measuring satisfaction in the claims process4.2Surveys and their interpretation4.3Proactive communication with the policyholder4.4Clarity in explaining decisions4.5Managing coverage denials4.6Complaints and grievances procedure4.7Customer service and ombudsman4.8Complaints to the supervisor4.9Root cause analysis of complaints4.10Practice: communication protocol for a coverage denial
5.1Claims department dashboard5.2Analysis of deviations and the claims queue5.3Prioritised improvement projects5.4Automation and its limits5.5Managing peaks in claims frequency5.6Fraud prevention without penalising honest customers5.7Reporting to management and governance5.8Benchmarking against the market5.9Service culture within the department5.10Practice: departmental improvement plan
6.1Choice of line of business and process6.2Diagnosis of the current situation6.3Defining standards and service agreements6.4Technical quality control system6.5Customer experience measurement plan6.6Complaints procedure6.7Dashboard and indicators6.8Phased improvement plan6.9Project report6.10Project defence
How you'll learn
100% online training on the SEIUM campus, with downloadable material, recorded classes and an assigned technical tutor. There are no fixed timetables: students progress at their own pace within the enrolment period, which makes it possible to combine the course with work.
Each module combines theory, guided reading of the original standard and applied exercises. The working software is Guidewire ClaimCenter, Duck Creek Claims, Power BI, Minitab, in free, academic or evaluation versions. Practicals are based on real procedures from technical quality audits of claim files, claims handling control sampling and analysis of customer complaints. Assessment is continuous, module by module, plus the final integrative project.
Build it end to end
Your final project follows the real engineering workflow, step by step, reviewed by your tutor.
Understand claims management as a service with measurable standards.
Apply quality models such as ISO 9001 and EFQM to the claims process.
Define technical quality controls over claim files and loss adjustments.
Manage complaints and grievances in accordance with ISO 10002 and sector regulations.
Measure customer satisfaction with reliable indicators.
Where this takes you
Requirements
- No prior qualification is required.
- Internet connection and a computer capable of running the programme's software.
- Sufficient level of Spanish to follow technical regulatory reading.
Ready to start?
Send your application today. Our admissions team replies within 72 hours with your study plan and funding options.
Frequently asked questions
The programme comprises 300 hours in total, spread over 3 to 5 months. This averages between 10 and 15 hours per week, compatible with a full-time job.
The course uses Guidewire ClaimCenter, Duck Creek Claims, Power BI and Minitab. Free, academic or evaluation versions are used, and the tutor indicates the free alternative where one exists.
A SEIUM Institute diploma upon passing the continuous assessment and the integrative project. It is in-house training, not an official title from the Ministry.
Yes. Modules passed in a course or postgraduate diploma in the same area are credited towards the advanced programme. Please review the credit transfer policy when you enrol.
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