HCA 111: The Claims Environment

Discussion Questions (Weeks 1-7)

30%

Quizzes (Weeks 1, 2, 4 & 5)

20%

Research Paper Due (Week 7)

30%

Final Cumulative Quiz (Week 8)

10%

Research Paper Presentation (Week 8)

10%

Total

100%

Week

SLOs

Readings and Exercises

Assignments

1

1, 2, 3, 10

Topics: Claims Fundamentals & Processes

Readings:

• Claims Handling Principles and Practice (Textbook). Chapter 2, "The Claims Handling Process" and Chapter 3, "Setting Case Reserves and Investigating Claims."

1. The claims representative should follow a systematic claim handling process that will help to ensure a claim is handled in good faith from start to finish. Please discuss one activity in the Claims Handling Process and expand on its
2. The claims representative should follow a systematic claim handling process that will help to ensure a claim is handled in good faith from start to finish. Please discuss one activity in the Claims Handling Process and expand on its relevance.

Quiz due this week based on chapter readings.

2

4

Topics: Communication and Claims

Readings:

• Textbook. Chapter 4, "Documenting Claims."

1. Discuss the differences between direct and open-ended questions. Provide an example of each and share which type of question is best and why.
2. There are advantages and disadvantages of recorded statements as compared to written statements that a claims representative must record when processing claims. Based on the chapter readings discuss at least two of each. Which method has the greatest advantage?

Quiz due this week based on chapter readings.

Note: Submit research paper proposed title for approval by Week 3. It should related to course material. See "Learning Activities" Section above.

3

4, 5

Topics: Fraud and the Legal System

Readings:

• Textbook. Chapter 6, "Dealing with Fraud."

1. Research and discuss a recent article that involved insurance fraud. Tie in this week's readings into your post.
2. Claims representatives must be sure to maintain a balance between suspicions of fraud vs. the possibility that a claim is legitimate despite the presence of at least one fraud indicator. Discuss two questions that could help a representative maintain balance during an investigation.

Submit research paper proposed title for approval.

4

6, 7, 10

• Textbook. Chapter 9, "Good-Faith Claim Handling."

1. Discuss the parties of a bad faith claim and provide an example.
2. Bring in outside research to describe HIPAA and share how this can affect good-faith claim handling.

Quiz due this week based on chapter readings.

Midterm grades posted during Week 4 for Weeks 1-3

5

8, 10

• Textbook. Chapter 1, "The Claim Function and Professional Ethics."

1. Explain why ethics and professionalism are important to a claim representative.
2. Describe the ethical and professional dilemmas claim representatives can face.

Quiz due this week based on chapter readings.

6

9, 10

• Textbook. Chapter 7, "Negotiating Claims."

1. Describe the negotiation techniques claim representatives should avoid and the reasons those techniques should be avoided.
2. Describe the four different types of negotiation and which style is generally best suited for use by claim representatives.
   
   

7

4

• Textbook. Chapter 5, "Communicating Effectively."

1. Given a bad-faith lawsuit against an insured, describe the activities a claim representative would perform to manage the lawsuit.

8

1-10

• None

• Research Paper to be presented to the class during Week 8. Discuss your paper teaching the class. Please do not present the formal paper submitted to me. You all can learn from each other.
• Cumulative quiz covering chapters 1-7 & 9 in the text.