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Suggested Study Flow for Learners
Suggested Study Flow 10 hours - Smartonline Course
Suggested Study Flow 10 hours - Smartonline Course
Smart Online Learning AI Mentor - Clarify Your Doubts
Module 1 – Claims Philosophy, Role & Industry Context
Module 1 Study Material
Lecture 1.1 Claims as the “Moment of Truth” & Customer Trust
MCQ - Lecture 1.1 Claims as the “Moment of Truth” & Customer Trust
Lecture 1.2 Link Between Underwriting, Indemnity & Claims Outcomes
MCQ - Lecture 1.2 Link Between Underwriting, Indemnity & Claims Outcomes
Module 2 – Overview of Claims Lifecycle
Module 2 Study Material
Lecture 2.1 End-to-End Claims Lifecycle & Key Process Stages
MCQ - Lecture 2.1 End-to-End Claims Lifecycle & Key Process Stages
Lecture 2.2 Operational Roles, Delay Points & Process Vulnerabilities
MCQ - Lecture 2.2 Operational Roles, Delay Points & Process Vulnerabilities
Module 3 – Life Insurance Claims Management
Module 3 Study Material
Lecture 3.1 Life Insurance Claim Types & Documentation Framework
MCQ - Lecture 3.1 Life Insurance Claim Types & Documentation Framework
Lecture 3.2 Early Claims, Investigations & Dispute Triggers
MCQ - Lecture 3.2 Early Claims, Investigations & Dispute Triggers
Module 4 – Health Insurance Claims Management
Module 4 Study Material
Lecture 4.1 Cashless vs Reimbursement Claims & Process Flow
MCQ - Lecture 4.1 Cashless vs Reimbursement Claims & Process Flow
Lecture 4.2 Role of Hospitals, TPAs & Documentation Complexity
MCQ - Lecture 4.2 Role of Hospitals, TPAs & Documentation Complexity
Lecture 4.3 Rejection Reasons, Fraud Risks & Overbilling Controls
MCQ - Lecture 4.3 Rejection Reasons, Fraud Risks & Overbilling Controls
Module 5 – General Insurance Claims Management
Module 5 Study Material
Lecture 5.1 Motor Insurance Claims – Process & Practical Challenges
MCQ - Lecture 5.1 Motor Insurance Claims – Process & Practical Challenges
Lecture 5.2 Fire & Property Claims – Loss Assessment & Documentation
MCQ - Lecture 5.2 Fire & Property Claims – Loss Assessment & Documentation
Lecture 5.3 Marine & Specialized Claims – Transit Risk & Complexity
MCQ - Lecture 5.3 Marine & Specialized Claims – Transit Risk & Complexity
Lecture 5.4 Miscellaneous Insurance Claims – Liability, Engineering & Specialty Lines
MCQ - Lecture 5.4 Miscellaneous Insurance Claims – Liability, Engineering & Specialty Lines
Lecture 5.5 Surveyors, Inspection & Operational Bottlenecks
MCQ - Lecture 5.5 Surveyors, Inspection & Operational Bottlenecks
Module 6 – Documentation & Evidence Evaluation
Module 6 Study Material
Lecture 6.1 Standard Documentation & Evidence Validation Framework
MCQ - Lecture 6.1 Standard Documentation & Evidence Validation Framework
Lecture 6.2 Documentation Gaps, Decision Points & Record Discipline
MCQ - Lecture 6.2 Documentation Gaps, Decision Points & Record Discipline
Module 7 – Claims Assessment & Decision-Making Framework
Module 7 Study Material
MCQ - Lecture 7.1 Understanding Policy Coverage in Claims
Lecture 7.2 Application of Exclusions & Insurance Principles in Claims
MCQ - Lecture 7.2 Application of Exclusions & Insurance Principles in Claims
Lecture 7.3 Decision Frameworks, Judgement & Borderline Cases
MCQ - Lecture 7.3 Decision Frameworks, Judgement & Borderline Cases
Module 8 – Fraud Detection, Red Flags & Claims Leakage
Module 8 Study Material
Lecture 8.1 Fraud Patterns & Behavioural Red Flags
MCQ - Lecture 8.1 Fraud Patterns & Behavioural Red Flags
Lecture 8.2 Claims Leakage, Investigation Triggers & Risk Impact
MCQ - Lecture 8.2 Claims Leakage, Investigation Triggers & Risk Impact
Module 9 – AI, Advanced Technology & Data-Driven Claims
Module 9 Study Material
Lecture 9.1 AI, Automation & Document Processing in Claims
MCQ - Lecture 9.1 AI, Automation & Document Processing in Claims
Lecture 9.2 AI-Based Fraud Detection & Remote Inspection Technologies
MCQ - Lecture 9.2 AI-Based Fraud Detection & Remote Inspection Technologies
Lecture 9.3 Telematics, IoT & Parametric Claims Models
MCQ - Lecture 9.3 Telematics, IoT & Parametric Claims Models
Module 10 – Claims Governance, Controls & Financial Impact
Module 10 Study Material
Lecture 10.1 Claims Reserving & Financial Impact on Insurers
MCQ - Lecture 10.1 Claims Reserving & Financial Impact on Insurers
Lecture 10.2 Claims Controls, Leakage & Approval Governance
MCQ - Lecture 10.2 Claims Controls, Leakage & Approval Governance
Lecture 10.3 Subrogation, Recovery & Governance Oversight
MCQ - Lecture 10.3 Subrogation, Recovery & Governance Oversight
Module 11 – Customer Experience, Complaints & Dispute Resolution
Module 11 Study Material
Lecture 11.1 Customer Communication & Experience During Claims
MCQ - Lecture 11.1 Customer Communication & Experience During Claims
Lecture 11.2 Grievance Redressal, Ombudsman & Dispute Handling
MCQ - Lecture 11.2 Grievance Redressal, Ombudsman & Dispute Handling
Module 12 – Regulatory Framework & Compliance Expectations
Module 12 Study Material
Lecture 12.1 Regulatory Guidelines, Timelines & Customer Protection
MCQ - Lecture 12.1 Regulatory Guidelines, Timelines & Customer Protection
Lecture 12.2 Documentation, Audit & Compliance Discipline in Claims
MCQ - Lecture 12.2 Documentation, Audit & Compliance Discipline in Claims
Module 13 – Real-World Decision-Making & Operational Challenges
Module 13 Study Material
Lecture 13.1 Handling Incomplete Documentation & Decision Under Ambiguity
MCQ - Lecture 13.1 Handling Incomplete Documentation & Decision Under Ambiguity
Lecture 13.2 Managing Stakeholder Pressure & Escalation Judgement
MCQ - Lecture 13.2 Managing Stakeholder Pressure & Escalation Judgement
Lecture 13.3 Balancing Overpayment Risk vs Wrongful Rejection
MCQ - Lecture 13.3 Understanding the Trade-Off in Claims Decisions
Module 14 – Case Studies, Landmark Judgments & Industry Impact
Module 14 Study Material
Lecture 14.1 Life Insurance Claim Disputes & Legal Interpretation
MCQ - Lecture 14.1 Life Insurance Claim Disputes & Legal Interpretation
Lecture 14.2 Health Insurance & Policy Interpretation Disputes
MCQ - Lecture 14.2 Health Insurance & Policy Interpretation Disputes
Lecture 14.3 General Insurance Claims, Liability & Industry Impact
MCQ - Lecture 14.3 General Insurance Claims, Liability & Industry Impact
Final Test
MCQ - Final Test
Mandatory Submission of Assignment
Project assignment
Project assignment
Submit Assignment
Final Exam/Assessment by BFSI Skill Sector Council
Frequently Asked Questions - BFSI SKill Council Final Exam
Frequently Asked Questions - BFSI SKill Council Final Exam
Please fill in this form to enable us to generate and issue your certificate once you have completed this course
Instruction for BFSI Final Remote Proctoring Exam
Reference Videos, Social Media Resources
Smart Online Course Youtube Channel
Risk Management Association Youtube Channel
RMAI Facebook Page
Smart Online Course Facebook Page
Linkedin Updates
Additional Resources
The Insurance Times April 2026
A Practical Understanding of General Insurance Underwriting and Claims Management
Intelligent_Insurance_Claims_Management_through_AI
Claims Lifecycle Management: A 2026 Operating Model Playbook
Modern Claims Management: Straight Through Processing Insurance Claims
What is Claims Management in Insurance?
Claims Lifecycle Management: A 2026 Operating Model Playbook
Toolkits and Templates
Insurance Claims Management Template
Boost Efficiency with a Claims Assessment Checklist
Claim Management Suite