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National College Credit Recommendation Service

Board of Regents  |  University of the State of New York

LOMA | Evaluated Learning Experience

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Insurance Administration (LOMA 301)

Formerly Insurance Administration (FLMI 301)
Location: 
Independent study and proficiency examination program administered from the central offices of LOMA.
Length: 

Varies-independent study.

Dates: 

Version 1: June 1997 - June 2002. Version 2: July 2002 - December 2007. Version 3: January 2008 - Present.

Instructional delivery format: 
Proficiency exam
Learner Outcomes: 

Version 1: Upon successful completion of the course, students will be able to: describe the insurance administration activities associated with underwriting individual and group life and health insurance; explain how reinsurance works and identify the fundamentals of administering reinsurance agreements; explain the process of administering claims for life, medical, and disability income insurance and recognize situations that may involve misrepresentation or fraud; recognize the importance of customer service and describe ways to provide quality service; and describe the process of administering annuities. Version 2: Students will be able to: describe the insurance administration activities associated with underwriting individual and group life and health insurance; explain how reinsurance works and identify the fundamentals of administering reinsurance agreements; explain the process of administering claims for life, medical, long-term care, and disability income insurance and recognize situations that may involve misrepresentation or fraud; and recognize the importance of customer service and describe ways to provide quality service. Version 3: Students will be able to: explain the importance of efficient administration practices to a company’s business processes, productivity, profitability, and compliance with regulatory and ethical standards; describe how marketing, actuarial, accounting, treasury operations, legal, compliance, human resources, and information technology coordinate with staff in insurance administration, notably underwriting, claim administration, reinsurance and customer service; describe how governments in the United States and Canada regulate discrimination, privacy, medical testing, replacements, money laundering, and financing terrorists during the underwriting process for both individual and group business; define key considerations, such as insurable interest, risk assessment and classification, suitability, information sources, and anti-selection that influence the decision to approve and issue insurance; how these determine whether coverage is preferred, standard, sub-standard, or declined; and if reinsurance may be necessary; list the basic features and underwriting considerations of various types of insurance, including multi-life policies, juvenile insurance policies, buy-sell agreements, key-person life insurance, split-dollar life insurance, creditor insurance and direct response policies; explain the importance of an insurer’s claim philosophy in guiding its claim practices, the steps it takes in evaluating a typical claim,  and any “red flags” that indicate potentially fraudulent claims; explain how claim analysts determine the proper payee for life insurance policy proceeds and describe situations involving the beneficiary, policy assignments, adverse claimants, community property laws, divorce, and simultaneous deaths that can complicate the payment process; recognize actions that qualify as unfair claim practices according to the NAIC Unfair Claims Settlement Practices Act, and requirements imposed on insurers by the NAIC Unfair Life, Accident and Health Claims Settlement Practices Model Regulation; describe how a database management system, data mining, predictive modeling, a business rules engine, a document management system, and an automated workflow system enhance insurance administration processes and reduce security risks; and identify the benefits to insurers of providing effective customer service including the typical ways that insurers organize customer service departments and the tools that automate and simplify customer service delivery.

Instruction: 

Version 1: Major topics include: scope and organization of underwriting; legal issues affecting underwriting; factors in underwriting individual life and health insurance; factors in underwriting specialized policies and supplemental coverages; group insurance underwriting principles and procedures; scope and organization of reinsurance; bases and plans of reinsurance; reinsurance treaties; reinsurance administration; scope and organization of claims; administering life, medical, LTC, and disability income insurance; claim administration; handling claim fraud; scope and organization of policy owner service; practices of policy owner service; administering annuities. Version 2: Major topics include: overview of insurance administration; scope and organization of underwriting; legal issues affecting underwriting; underwriting individual life and health insurance; personal and financial factors for individual life insurance; underwriting specialized policies and supplemental coverages; underwriting group coverage; scope and organization of reinsurance; reinsurance forms and treaties; reinsurance administration; scope and organization of claim administration; administering life, medical, long-term care, disability income, and critical illness claims; scope and organization of customer service; customer service practices. Version 3: This course describes the principles and practices of individual and group life and health insurance administration and provides an overview of insurance administration functions and systems as well as discussions of underwriting, reinsurance, claim administration, and customer service for life and health insurance. Major topics include: overview of new business processing and underwriting; legal aspects of underwriting; assessing mortality risk for individuals; financial underwriting and risk classification; underwriting special policies and supplemental benefits; underwriting for individual health insurance; underwriting group life and health insurance; overview of reinsurance; types of reinsurance and reinsurance agreements; reinsurance administration; overview of claim administration; administering claims for life, medical expenses, critical illness, long-term care, and disability income insurance; overview of customer service; and customer service practices.

Credit recommendation: 

Version 1, 2, and 3: In the lower division baccalaureate/associate degree category 3 semester hours in Insurance (12/97) (6/02 revalidation) (1/08 revalidation) (10/12 revalidation) (3/20 revalidation). 

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