Ethics in Claims Management Course
Online 300 h course in ethics in claims management. 6 modules covering Law 50/1980 on Insurance Contracts, Order ECO/734/2004 (customer service and ombudsman services) and Guidewire ClaimCenter. Assigned tutor and open enrolment.
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What you will be able to do
Recognise the ethical dimension of decisions in claims management.
Apply criteria of fairness and consistency in coverage decisions.
Design protocols for fair treatment and communication with the policyholder.
Distinguish between legitimate fraud prevention and undue suspicion.
Implement whistleblowing channels and integrity mechanisms that comply with the law.
Promote a culture of ethical governance within claims teams.
Develop an integrative project with a code of conduct applied to claims.
Who it's for
- Ethics and compliance manager in claims who wants to specialise in Ethics in Claims Management.
- Senior claims handler who wants to specialise in Ethics in Claims Management.
- Customer ombudsman at an insurer who wants to specialise in Ethics in Claims Management.
- Insurance fraud investigator who wants to specialise in Ethics in Claims Management.
- Internal claims auditor who wants to specialise in Ethics in Claims Management.
- Organisational culture consultant who wants to specialise in Ethics in Claims Management.
- Engineering or science graduates seeking to enter insurance companies.
What you'll work with
- Law 50/1980 on Insurance Contracts
- Order ECO/734/2004 (customer service and ombudsman services)
- Directive (EU) 2019/1937 (protection of whistleblowers)
- Law 2/2023 (protection of informants)
- ISO 37301 (compliance management systems)
- ISO 37001 (anti-bribery management systems)
- Law 20/2015 (LOSSEAR)
6 modules · 300 h
1.1Asymmetry of information and power1.2Duty of good faith on both sides1.3The claims handler between the insurer and the policyholder1.4Cost pressure and its effects1.5Difficult cases and grey areas1.6Ethical frameworks applicable to decision-making1.7Professional codes of conduct in the sector1.8Sector vocabulary and acronyms1.9Public trust in insurance1.10Exercise: analysing a case with explicit criteria
2.1Interpreting the policy wording2.2Restrictive and unfair clauses2.3Burden of proof and its allocation2.4Applying exclusions judiciously2.5Misstatement in the declaration of risk2.6Under-insurance and the proportional rule2.7Decisions on doubtful claims2.8Honest justification of a refusal2.9Review of decisions and correction2.10Practice: justifying a difficult decision
3.1Clear communication without jargon3.2Realistic expectations from the outset3.3Attention to people in vulnerable situations3.4Managing bereavement and serious situations3.5Respect during the claim investigation3.6Avoiding practices that wear down the claimant3.7Settlement offers and their fairness3.8Information on complaint routes3.9Non-discriminatory treatment3.10Practice: protocol for handling vulnerable customers
4.1Proportionality in investigation4.2Presumption of the policyholder's good faith4.3Use of data and models in detection4.4Model bias and its review4.5Sufficient evidence before making an accusation4.6Collaboration with authorities4.7Internal and supplier fraud4.8Conflicts of interest with loss adjusters and repairers4.9Gifts and relationships with the network4.10Practice: ethical assessment of an anti-fraud protocol
5.1Team incentives and their effects5.2Indicators that reward correct conduct5.3Internal alert channel and its protection5.4Ethics training for the team5.5Supervision of sensitive decisions5.6Committee for complex cases5.7Transparency in reporting to management5.8Accountability to the regulator5.9Reputation and long-term trust5.10Practice: ethics policy for the claims department
6.1Choosing the line of business and typical cases6.2Map of ethical dilemmas in the process6.3Explicit decision criteria6.4Communication and treatment protocol6.5Ethical review of anti-fraud measures6.6Design of coherent incentives6.7Training and supervision plan6.8Conduct indicators6.9Project report6.10Defence of the work
How you'll learn
100 % online training on the SEIUM campus, with downloadable material, recorded classes and an assigned technical tutor. No fixed timetable: students progress at their own pace within the intake, which makes it possible to combine study with work.
Each module combines theory, guided reading of the original standard and applied exercises. The working software is Guidewire ClaimCenter, FRISS, Excel advanced, Power BI, in free, academic or evaluation versions. Tests are studied on real procedures for analysing coverage refusal cases, fair treatment audits of policyholders, and review of files with signs of fraud. 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.
Recognise the ethical dimension of decisions in claims management.
Apply criteria of fairness and consistency in coverage decisions.
Design protocols for fair treatment and communication with the policyholder.
Distinguish between legitimate fraud prevention and undue suspicion.
Implement whistleblowing channels and integrity mechanisms that comply with the law.
Where this takes you
Requirements
- No prior qualification is required.
- Internet connection and a computer capable of running the programme's software.
- Sufficient 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 totals 300 hours spread over 3 to 5 months. That is between 10 and 15 hours per week on average, compatible with a full-time job.
You work with Guidewire ClaimCenter, FRISS, Excel advanced and Power BI. Free, academic or evaluation versions are used, and the tutor indicates the free alternative where one exists.
An own diploma from SEIUM upon passing the continuous assessment and the integrative project. It is in-house training, not an official qualification from the Ministry.
Yes. Modules passed in a Course or Postgraduate Diploma in the same area are recognised towards the higher programme. Check the recognition policy when you enrol.
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