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LOMA 301 — Insurance Administration

Course Type: Course Portal, Traditional Designation Course
Topics: Life Insurance, Operations & Administration
Designations: ACS, AIAA, ALMI, ARA, CPLHI, FLMI, PFLP, PFSL
Language: Bahasa Indonesia, Chinese (simplified), Chinese (traditional), English, French, Korean, Portuguese, Spanish


Overview

LOMA 301 provides a detailed discussion of the activities of insurance administration for individual and group life coverages, focusing on underwriting, reinsurance, claims, and customer service.

Topics

  • Overview of Insurance Administration
  • New Business Process and Underwriting Principles
  • Legal Aspects of Underwriting
  • Underwriting Individual Life Insurance: Assessing Mortality Risk
  • Underwriting Individual Life Insurance: Financial Underwriting and Risk Classification
  • Niche Policies, Business Life Insurance, Replacements and Supplemental Benefits
  • Underwriting Group Life Insurance
  • Overview of Claim Administration
  • Administering Life Insurance Claims
  • Reinsurance Overview
  • Reinsurance Administration
  • Effective Customer Service
  • Customer Service Practices

Module 1: Introduction to Insurance Administration

Chapter 1: Overview of Insurance Administration

Insurers’ Ethical Duties to Customers

Equity in Risk Acceptance

Prompt and Equitable Claim Handling

Honest, Objective, and Fair Customer Service

Privacy and Confidentiality of Customer Information

Adequate Financial Resources

Insurance Administration Functions

Underwriting

Claim Administration

Reinsurance

Customer Service

Other Insurance Functions

Marketing

Actuarial

Accounting and Treasury Operations

Legal and Compliance

Human Resources

Information Technology

Administration Systems

Technology Components

Technologies that Enhance Insurance Administration Processes

Systems Integration

Security

Quality Control

Chapter 2: New Business Processing and Underwriting Principles

New Business Process

Field Underwriting

Teleunderwriting

Data Entry and Review

Underwriting

Policy Issue

New Business/Underwriting Quality Control

Underwriting Principles

Risk Assessment

Risk Classification

Underwriting Philosophy and Underwriting Guidelines

Underwriting Organization

Job Positions

Authority Levels

Organizational Systems

Chapter 3: Legal Aspects of Underwriting

Premium Receipts

Insurable Interest

Regulatory Compliance Issues Affecting Individual Insurance Underwriting

Privacy Protection

Nondiscrimination

Medical Testing

Replacements

Money Laundering and Financing Terrorists

Regulatory Compliance Issues Affecting Group Insurance Underwriting

U.S. State Regulatory Requirements

U.S. Federal Regulatory Requirements

Canadian Regulatory Requirements

Underwriting Standards

Reviewing Applications for Proper Completion

Processing Applications Promptly

Documenting Underwriting

Module 2: Underwriting

Chapter 4: Underwriting Individual Life Insurance: Assessing Mortality Risk

Medical Risk Factors

Sources of Medical Information

Assessing Medical Factors

Personal Risk Factors

Sources of Personal Information

Assessing Personal Factors

Chapter 5: Underwriting Individual Life Insurance: Financial Underwriting and Risk Classification

Financial Underwriting

Risks Deterred by Financial Underwriting

Sources of Financial Information

Assessing Life Insurance Needs and Financial Factors

Tools to Determine the Appropriate Amount of Insurance

Risk Classification

Numerical Rating System

Charging for Substandard Risks

Chapter 6: Niche Policies, Business Life Insurance, Replacements, and Supplemental Benefits

Underwriting Niche Policies

Multi-Life Policies

Juvenile Insurance Policies

Direct Response Policies

Underwriting Business Life Insurance

Financial Assessment of a Business

Underwriting Considerations for Various Types of Business Life Insurance

Underwriting Policy Replacements

Underwriting Supplemental Benefits

Waiver of Premium for Disability Benefit

Accidental Death Benefit

Family Benefit

Guaranteed Insurability Benefit

Accelerated Death Benefits

Chapter 7: Underwriting Group Life Insurance

Group Underwriting Process

Information Sources for Group Underwriting

Request for Proposal

Producer’s Letter

ERISA Documents

The Master Application

Risk Factors for Group Underwriting

The Group Prospect

The Proposed Coverage

Rating Methods for Group Cases

Manual Rating

Experience Rating

Blended Rating

Rating Approaches for Small Groups

Post-Issue Underwriting for Group Insurance

Underwriting of Late Enrollees

Renewal Underwriting

Module 3: Claim Administration

Chapter 8: Overview of Claim Administration

Claim Philosophy and Claim Practices

Claim Evaluation Process

Claim Staffing and Organization

Staffing

Authority Levels

Organizational Systems

Relationships with Other Insurer Functions

Legal Issues Affecting Claim Administration

Unfair Claims Settlement Practices

Privacy

Financing Terrorists

Fraud

Quality Control

Technology

Chapter 9: Administering Life Insurance Claims

Evaluating Life Insurance Claims

Verifying the Coverage Was in Force

Verifying that the Deceased Is Covered

Verifying the Death Occurred

Determining Whether the Policy Is Contestable

Determining Whether the Death Is Covered

Calculating the Amount of the Policy Proceeds and How They Are Payable

Determining Who Is Entitled to Receive the Policy Proceeds

Handling Supplemental Benefits

Waiver of Premium for Disability Benefit

Accidental Death Benefit

Family Benefit

Accelerated Death Benefit

Module 4: Reinsurance

Chapter 10: Reinsurance Overview

Roles of Insurance Companies in Reinsurance Arrangements

Indemnity Reinsurance

Assumption Reinsurance and Indemnity Reinsurance

Basic Financial Aspects of Indemnity Reinsurance

Purposes of Indemnity Reinsurance for the Direct Writer

Cession Arrangements in Reinsurance

Automatic Reinsurance

Facultative Reinsurance

Facultative-Obligatory Reinsurance

Risk-Sharing Arrangements

Nonproportional Reinsurance and Proportional Reinsurance

Cession Amounts in Proportional Reinsurance

Plans of Reinsurance

Coinsurance

Modified Coinsurance

Yearly Renewable Term Reinsurance

Reinsurance Agreements

Defining the Reinsurance Coverage

Reinsurance Administration Procedures

Potential Problems between a Direct Writer and a Reinsurer

Reinsurance Rates and Payments

Chapter 11: Reinsurance Administration

Reinsurance Staffing and Systems

Reinsurance Analysts

Other Staff Involved in Reinsurance Activities

Reinsurance Information Systems

Administering New Business

Preplacement of Reinsurance

Placement of Reinsurance

Administering In-Force Business

Administering Terminations of Reinsurance

Administering Claims under Reinsured Policies

Establishing the Claim File

Verifying Claim-Related Information

Approving the Claim Liability

Settling the Claim Liability

Notifying Retrocessionaires of a Claim Liability

Auditing Reinsurance Operations

Internal Audits

External Audits by the Reinsurer

Module 5: Customer Service

Chapter 12: Effective Customer Service

Qualities of Effective Customer Service

Benefits of Providing Effective Customer Service

Customer Service Organization

Staffing

Levels of Authority

Organization

Legal Issues Affecting Customer Service

Delivering Effective Customer Service

Service for Policyowners, Insureds, Beneficiaries, and Producers

Determining Strategies for Effective Customer Service

Automating and Simplifying Customer Service Delivery

Ensuring Excellent Telephone Communication

Documenting Customer Service Guidelines and Procedures

Customer Service and Conservation

Conservation Through Communication with Policyowners

Conservation of Orphan Policyowners

Conservation Through Superior Claim Service

Conservation Through Customer Feedback

Conservation Through Producers

Chapter 13: Customer Service Practices

Customer Service Quality Control

Quantitative Performance Measurement

Qualitative Performance Measurement

Customer Service Transactions

Routine Customer Service Transactions

More Complex Customer Service Transactions

Glossary

Index

Course Format

Course Portals include the following elements:

  • PDFs of the assigned course materials that can be printed or read online
  • The same interactive Practice Questions and Sample Exams currently found in LOMA Test Preparation Guides (TPGs)
  • Recommended study plans to help learners set goals and manage their study schedule
  • A variety of additional media-oriented features designed to enhance the study and review process

Exam Format

The LOMA 301 exam has 60 questions and a time limit of 2 hours. It is available in I*STAR, Prometric, and Paper exam formats.

Study Materials

Insurance Administration, Fourth Edition (LOMA, 2011)
ISBN 978-1-57974-354-3

Test Preparation Guide for LOMA 301 (LOMA, 2011)
ISBN 978-1-57974-355-0

Optional printed textbook (not included in bundled fee)

Insurance Administration, Fourth Edition (LOMA, 2011)
ISBN 978-1-57974-354-3
PBD Order # 301-10-11

About Bundled Study Materials

Some courses ("bundled courses") include study materials with your enrollment. A growing list of English-language courses include access to bundled study materials.

For some of these courses, once you enroll, you gain access to the study materials through your My Learning page in LOMANET. These include the Course Portal courses and the Need 2 Know courses.

How to Enroll

Enrolling for Exams and Bundled Courses

LOMA requires proctored examinations for many of its professional designation courses. Exams are administered in LOMA member organizations and in independent testing locations. This section provides information about exam formats, enrollment procedures for both exams and bundled courses, and exam fees.

LOMA exams vary in length from two–three hours. Consult your Test Preparation Guide (TPG) or see the Designation Study Materials Roadmap for specific information about the length of your exam. As new or revised LOMA courses are released, the number of examination questions for some course examinations may change. If you enroll for a bundled course delivered through a LOMA Course Portal, the assigned study materials are included in your enrollment and are accessible via the Course Portal. Your enrollment process will depend on the type of examination you choose to take:

LOMA offers two options for exam enrollment:

  • Online enrollment via LOMANET, our Internet-based education administration system
  • Enrollment forms for paper exams, for use by independent students only, can be found here.

I*STAR and Paper Exam Center Directories for testing at third-party locations

Retakes

Students who fail exams must pay full dates to retake the exams, in most cases. However, bundled courses (those courses that include exam fees and study materials) have a reduced rate to retake the exam. See LOMA’s Education & Training Catalog for fees.


See the LOMA 301 video

LOMA 301