Auditing Insurance Claims and Underwriting Training Course

Summary

The Auditing Insurance Claims and Underwriting Training Course is a results-driven program built for professionals who are responsible for evaluating the accuracy, integrity, and financial soundness of insurance operations. This course positions auditing insurance claims and underwriting as a core organisational discipline rather than a routine back-office task, equipping participants with the frameworks, tools, and analytical judgment needed to review claims handling, underwriting decisions, and reserve calculations with precision. Delivered by Geneva Institute of Business Management, this program sits within the institute's Review and Audit Training Courses category, reflecting its direct relevance to internal audit, compliance, and risk management functions across the insurance sector.

Participants will move through a structured curriculum covering claims fraud detection, underwriting accuracy review, and reserve adequacy testing, building the technical competence to identify irregularities, quantify exposure, and strengthen governance controls. The course blends regulatory knowledge with practical audit methodology, giving auditors, underwriters, and compliance officers a shared vocabulary and a consistent framework for evaluating risk across claims files, underwriting decisions, and reserve positions. By the end of the program, participants will be able to conduct end-to-end audits of insurance claims and underwriting activity that hold up to regulatory scrutiny and support sound financial reporting.

Objectives

This course is structured around measurable, job-relevant outcomes that translate directly into improved audit performance and stronger organisational controls.

By completing this program, participants will be able to:

• Apply a structured methodology for auditing insurance claims and underwriting activity across multiple lines of business
• Detect indicators of claims fraud using data patterns, documentation gaps, and behavioural red flags
• Conduct an underwriting accuracy review that evaluates risk selection, pricing consistency, and adherence to underwriting guidelines
• Perform reserve adequacy testing to confirm that loss reserves reflect true financial exposure
• Evaluate internal controls governing claims processing and underwriting approval workflows
• Prepare audit documentation and findings that meet regulatory and internal governance standards
• Communicate audit results to stakeholders in a manner that supports corrective action and process improvement
• Use analytical and sampling techniques to prioritise high-risk files for detailed review
• Align audit practices with current regulatory expectations and industry benchmarks

Target Audience

This program is designed for professionals whose responsibilities intersect with claims oversight, underwriting governance, or insurance audit functions, including:

• Internal auditors working within insurance and reinsurance organisations
• Claims managers and senior claims examiners responsible for quality oversight
• Underwriters and underwriting managers seeking a stronger audit-oriented perspective
• Risk management and compliance officers overseeing insurance operations
• Actuarial analysts involved in reserve reviews and loss forecasting
• Regulatory compliance teams responsible for insurance audit readiness
• Insurance operations managers overseeing claims and underwriting departments
• External auditors and consultants serving insurance sector clients
• Finance and reporting teams responsible for reserve accuracy and financial statement integrity

Modules

Module 1: Foundations of Insurance Claims and Underwriting Audits

This module introduces the scope, purpose, and structure of auditing insurance claims and underwriting operations. Participants examine how audit functions fit within the broader insurance value chain, the relationship between claims accuracy and underwriting discipline, and the key risk areas that audit programs are designed to address. The module establishes a common language for the course, covering audit objectives, control environments, and the role of audit findings in shaping organisational risk appetite.

Module 2: Regulatory and Compliance Frameworks for Insurance Auditing

Participants gain a working understanding of the regulatory landscape governing insurance claims and underwriting activity, including solvency requirements, consumer protection standards, and reporting obligations. The module explains how regulatory expectations shape audit scope and documentation requirements, and how auditors can build compliance checkpoints directly into their review methodology. Emphasis is placed on maintaining audit trails that satisfy both internal governance and external regulatory review.

Module 3: Claims Fraud Detection Techniques and Red Flag Identification

This module focuses squarely on claims fraud detection, equipping participants with practical techniques for identifying suspicious patterns in claims data, documentation, and claimant behaviour. Topics include common fraud typologies, red flag indicators, network and pattern analysis, and the use of analytics to flag outlier claims for further investigation. Participants practice applying these techniques to sample claims files, building confidence in distinguishing legitimate claims from those warranting deeper scrutiny.

Module 4: Underwriting Accuracy Review and Risk Selection Assessment

Here, the course shifts focus to underwriting accuracy review, examining how auditors evaluate the quality and consistency of underwriting decisions. Participants learn to assess whether risk selection aligns with underwriting guidelines, whether pricing reflects the true risk profile, and whether exceptions and overrides are properly documented and justified. The module also covers techniques for identifying underwriting drift, where decisions gradually deviate from established standards over time.

Module 5: Reserve Adequacy Testing and Loss Reserve Analysis

This module addresses reserve adequacy testing as a critical audit function, teaching participants how to evaluate whether reported reserves accurately reflect expected claim payouts. Coverage includes reserve estimation methods, trend and development analysis, and techniques for identifying under-reserving or over-reserving patterns that could distort financial statements. Participants work through practical exercises to test reserve calculations against historical claims development data.

Module 6: Data Analytics and Technology in Insurance Audit

Participants explore how data analytics tools support modern insurance auditing, from automated anomaly detection to predictive modelling for claims fraud detection and reserve forecasting. The module covers how to structure data queries, interpret analytical outputs, and integrate technology-driven insights into traditional audit workflows without losing the judgment-based rigour that audit work requires.

Module 7: Claims File Review and Documentation Standards

This module walks participants through a structured approach to reviewing individual claims files, covering documentation completeness, adjuster decision-making, payment accuracy, and compliance with internal claims handling policies. Participants learn to identify gaps in documentation that may indicate process weaknesses or elevated fraud risk, and how to record findings in a way that supports consistent audit reporting.

Module 8: Underwriting Guidelines Compliance and Policy Pricing Review

Building on the underwriting accuracy review theme, this module examines how auditors verify compliance with underwriting guidelines and pricing models. Topics include reviewing policy terms against risk classifications, testing pricing calculations, and identifying instances where underwriting exceptions were granted without adequate justification. The module strengthens participants' ability to evaluate underwriting files with the same rigour applied to claims files.

Module 9: Audit Reporting, Findings Communication and Corrective Action Planning

Participants learn how to translate audit findings into clear, actionable reports that support decision-making at the management and board level. The module covers structuring audit reports, prioritising findings by risk severity, and working with claims and underwriting teams to develop corrective action plans. Emphasis is placed on communication techniques that encourage constructive engagement rather than defensive responses from audited departments.

Module 10: Case Studies and Practical Audit Simulations

The final module consolidates learning through realistic case studies covering claims fraud detection, underwriting accuracy review, and reserve adequacy testing scenarios. Participants work individually and in groups to conduct simulated audits, apply the frameworks covered throughout the course, and present their findings. This module is designed to build practical confidence before participants apply these skills in their own organisations.

FAQs

What is the main focus of this course?

The course focuses on building practical competence in auditing insurance claims and underwriting, covering claims fraud detection, underwriting accuracy review, and reserve adequacy testing as core skill areas.

Who should enrol in this program?

The program is designed for internal auditors, claims managers, underwriters, compliance officers, actuarial analysts, and risk management professionals working within the insurance sector.

Does this course cover regulatory compliance requirements?

Yes. The curriculum includes a dedicated module on regulatory and compliance frameworks that shape how claims and underwriting audits are planned, documented, and reported.

Will participants work with practical case studies?

Yes. The final module includes practical audit simulations and case studies that allow participants to apply claims fraud detection, underwriting accuracy review, and reserve adequacy testing techniques to realistic scenarios.

Which category does this course belong to at Geneva Institute of Business Management?

This course is part of the Review and Audit Training Courses category at Geneva Institute of Business Management.