Course Introduction
Insurance premium and claims transactions involve significant financial values, complex contractual arrangements, multiple data sources, and substantial risks of error, leakage, misstatement, and fraud. Effective financial auditing requires an understanding of how policies are issued, premiums are calculated and collected, claims are submitted and settled, recoveries are recognized, and financial information flows into accounting and reporting systems. Insurance Premium and Claims Financial Auditing Training Course provides a practical framework for auditing these processes from both financial control and substantive testing perspectives.
Premium auditing requires careful examination of policy records, premium calculations, rates, commissions, taxes, discounts, cancellations, endorsements, refunds, and receivables. Participants will learn how to reconcile policy administration systems with accounting records and cash collections, test premium completeness and accuracy, and identify unusual adjustments or transactions. The course also addresses cut-off, deferred or unearned amounts, receivables, credit notes, refunds, and other financial reporting considerations associated with insurance premiums.
Claims represent another significant area of financial and operational risk. Auditors need to determine whether claims are genuine, properly authorized, accurately valued, supported by appropriate documentation, and settled in accordance with applicable policy terms and internal procedures. Participants will learn how to test claim files, settlement calculations, payment records, supporting evidence, approval controls, and claim-related accounting entries while maintaining appropriate professional skepticism.
The course examines financial risks associated with claims reserves, outstanding claims, recoveries, deductibles, salvage, subrogation, reinsurance, and settlement adjustments. Participants will learn how to assess the completeness and accuracy of claims-related balances and identify unusual movements requiring further investigation. Particular attention is given to the relationship between operational claims information and financial records, enabling auditors to identify discrepancies between claim systems, payment records, reserves, and general ledger balances.
Insurance fraud can occur through fabricated policies, manipulated premiums, fictitious claims, inflated losses, duplicate settlements, staged events, collusion, unauthorized adjustments, and abuse of claims processes. The course develops practical skills for recognizing fraud indicators and using transaction analysis, relationship analysis, exception testing, documentation review, and data analytics to identify suspicious patterns. Participants will also examine risks associated with internal and external parties, including policyholders, intermediaries, service providers, assessors, repairers, brokers, and employees.
Technology is transforming insurance operations through automated underwriting, digital policy administration, claims platforms, electronic payments, artificial intelligence, machine learning, telematics, automated claims assessment, and cloud-based financial systems. The course addresses the audit implications of these technologies, including automated calculations, system access, data integrity, model dependencies, cybersecurity, audit trails, and changes to business rules. By the end of the course, participants will be able to perform risk-based premium and claims audits, evaluate controls, conduct substantive testing, analyze financial data, investigate exceptions, and prepare evidence-based audit findings and recommendations.
Duration
5 days
Who Should Attend
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Internal auditors working in insurance companies and insurance-related financial operations.
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Financial auditors reviewing insurance premium and claims transactions.
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Insurance accountants responsible for premium, claims, receivables, and settlement accounting.
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Claims auditors reviewing claims processing, authorization, valuation, and payment controls.
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Finance managers overseeing insurance accounting and financial reporting.
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Risk and compliance professionals assessing insurance financial and operational risks.
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Claims managers responsible for claims governance and financial controls.
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Underwriting professionals seeking stronger understanding of premium-related financial controls.
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Reinsurance and insurance finance professionals reviewing recoveries and related financial records.
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Fraud investigators examining suspicious claims, premium manipulation, or settlement irregularities.
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Accounts receivable professionals managing premium collections and policyholder balances.
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Accounts payable professionals processing claims and service-provider payments.
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Actuarial and financial professionals working with claims reserves and financial information.
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Regulatory and compliance audit professionals reviewing insurance financial processes.
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Data analytics and finance transformation professionals supporting insurance audit and monitoring.
Course Objectives
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Explain the financial audit lifecycle for insurance premiums and claims, including policy administration, accounting, collection, settlement, recovery, and reporting.
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Evaluate internal controls over policy records, premium calculations, billing, collections, claims processing, settlement, recoveries, and financial reporting.
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Audit premium transactions for completeness, accuracy, occurrence, authorization, classification, cut-off, and consistency with policy documentation.
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Test claims for validity, policy coverage, supporting evidence, valuation, authorization, settlement accuracy, payment, and appropriate accounting treatment.
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Assess claims-related balances including outstanding claims, recoveries, deductibles, salvage, subrogation, and other significant financial components.
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Reconcile policy administration and claims systems with general ledger balances, receivables, bank transactions, payment records, and supporting documentation.
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Identify fraud indicators involving fictitious policies, inflated claims, duplicate settlements, manipulated premiums, unauthorized refunds, collusion, and false documentation.
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Apply data analytics and automated audit procedures to identify unusual premium, claims, payment, policyholder, supplier, and settlement patterns.
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Evaluate technology-enabled insurance controls, automated calculations, system access, audit trails, data integrity, cybersecurity, and AI-supported processes.
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Prepare well-supported audit findings and recommendations that strengthen premium controls, claims governance, financial reporting, fraud prevention, and continuous monitoring.
Comprehensive Course Outline
Module 1: Insurance Premium and Claims Financial Audit Fundamentals
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Principles, objectives, scope, and risk-based approaches for auditing insurance premium and claims financial processes.
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Understanding the relationship between underwriting, policy administration, premium collection, claims management, accounting, and financial reporting.
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Key audit assertions covering occurrence, completeness, accuracy, valuation, authorization, classification, cut-off, and existence.
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Developing an insurance audit strategy based on premium volumes, claims values, product types, transaction complexity, and identified risk areas.
Module 2: Insurance Premium Accounting and Revenue Controls
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Auditing policy records, premium calculations, rates, discounts, commissions, taxes, endorsements, cancellations, and premium adjustments.
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Testing premium billing and collection processes and reconciling policy administration records with invoices, receivables, and cash collections.
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Evaluating controls over premium receivables, credit notes, refunds, cancellations, write-offs, and adjustments.
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Reviewing premium cut-off, deferred amounts, unearned premium balances, and other financial reporting considerations.
Module 3: Policy Administration, Intermediaries, and Premium Reconciliation
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Auditing policy master data for completeness, accuracy, authorization, effective dates, coverage details, insured parties, and policy status.
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Reconciling policy administration systems with general ledger accounts, premium registers, broker records, bank collections, and receivable balances.
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Testing broker, agent, intermediary, and distribution-related premium transactions, commissions, adjustments, and settlements.
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Identifying duplicate policies, unusual cancellations, unexplained premium adjustments, inactive accounts, and other policy administration anomalies.
Module 4: Claims Processing and Financial Control Auditing
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Understanding the claims lifecycle from notification and registration through assessment, approval, settlement, payment, closure, and recovery.
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Testing claims documentation, policy coverage, incident evidence, loss assessments, approvals, settlement calculations, and payment records.
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Evaluating controls over claims authorization, delegation of authority, payment processing, claim amendments, reopening, and closure.
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Identifying duplicate claims, unsupported settlements, unusual claim frequency, excessive settlement values, and inappropriate adjustments.
Module 5: Claims Valuation, Reserves, and Financial Reporting
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Auditing outstanding claims, claims incurred, settlement costs, reserves, adjustments, and other claims-related financial balances.
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Testing claims valuation assumptions, supporting documentation, calculation accuracy, approval procedures, and changes to recorded amounts.
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Reconciling claims registers and settlement systems with general ledger balances, payment records, bank accounts, and supporting schedules.
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Evaluating financial reporting implications of incomplete claims records, inaccurate valuation, incorrect cut-off, and unsupported claims adjustments.
Module 6: Claims Payments, Recoveries, and Reinsurance Transactions
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Auditing claims payments, settlement instructions, beneficiaries, bank details, payment approvals, and reconciliation procedures.
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Testing recoveries from third parties, salvage, subrogation, deductibles, and other amounts that reduce or offset claims costs.
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Reviewing reinsurance arrangements and testing ceded premiums, recoveries, receivables, settlements, and related financial records.
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Identifying delayed recoveries, unsupported offsets, duplicate payments, incorrect allocations, and unexplained differences between claims and recovery records.
Module 7: Fraud Risks, Suspicious Transactions, and Financial Leakage
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Identifying fraud risks involving fictitious policies, fabricated claims, inflated losses, duplicate settlements, false documentation, and unauthorized payments.
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Examining risks involving collusion among employees, policyholders, brokers, assessors, repairers, healthcare providers, suppliers, and other external parties.
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Using transaction patterns, relationship analysis, exception testing, and professional skepticism to identify suspicious claims and premium activity.
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Conducting preliminary investigation procedures, evidence evaluation, transaction tracing, loss quantification, and escalation of significant anomalies.
Module 8: Technology, Data Analytics, AI, and Emerging Insurance Risks
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Auditing policy administration platforms, claims management systems, digital payment platforms, ERP systems, and integrated insurance applications.
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Applying data analytics to identify duplicate policies, unusual premium changes, abnormal claims frequency, repeated beneficiaries, and unusual settlement patterns.
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Evaluating automated claims decisions, AI-supported assessment, machine-learning models, telematics, system rules, access controls, and audit trails.
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Assessing cybersecurity, data integrity, model governance, system configuration, unauthorized changes, and emerging risks within digital insurance environments.
Module 9: Audit Evidence, Analytical Procedures, and Financial Reporting
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Designing substantive tests and analytical procedures for premiums, claims, receivables, payments, reserves, recoveries, and related financial balances.
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Evaluating the reliability, completeness, accuracy, and consistency of information obtained from policy and claims administration systems.
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Documenting reconciliations, recalculations, confirmations, exception testing, analytical results, management explanations, and audit conclusions.
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Assessing the effect of identified errors, control deficiencies, valuation issues, and unusual transactions on financial reporting and management information.
Module 10: Audit Reporting, Remediation, and Practical Case Studies
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Developing clear audit findings covering premium leakage, claims weaknesses, control deficiencies, unsupported transactions, valuation issues, and fraud indicators.
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Performing root cause analysis to determine whether problems arise from system weaknesses, policy gaps, poor supervision, process failures, or external-party risks.
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Formulating recommendations for stronger policy controls, claims governance, reconciliation procedures, payment controls, analytics, and fraud monitoring.
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Applying the complete premium and claims audit methodology through practical case studies involving premium manipulation, suspicious claims, payment anomalies, and recovery issues.
Training Approach
This course will be delivered by our skilled trainers who have vast knowledge and experience as expert professionals in the fields. The course is taught in English and through a mix of theory, practical activities, group discussion and case studies. Course manuals and additional training materials will be provided to the participants upon completion of the training.
Tailor-Made Course
This course can also be tailor-made to meet organization requirement. For further inquiries, please contact us on: Email: training@upskilldevelopment.com Tel: +254 721 331 808
Training Venue
The training will be held at our Upskill Training Centre. We also offer training for a group (at a discount of 10% to 50%) at requested location all over the world. The Onsite course fee covers the course tuition, training materials, two break refreshments, buffet lunch, airport transfers, Upskill gift package, and guided tour.
Visa application, travel expenses, dinners, accommodation, insurance, and other personal expenses are catered by the participant
Certification
Participants will be issued with Upskill certificate upon completion of this course.
Airport Pickup and Accommodation
Airport pickup and accommodation is arranged upon request. For booking contact our Training Coordinator through Email: training@upskilldevelopment.com, +254 721 331 808
Terms of Payment:
Unless otherwise agreed between the two parties’ payment of the course fee should be done 3 working days before commencement of the training so as to enable us to prepare better.
