Claims Operations: A Practical Guide

Addresses both claims handling issues and claims operations.

A book for everyone, whether you are a risk manager trying to evaluate a TPA, an agent trying to set up an in-house claims advisory service, an experienced P&C claims executive, or a newcomer to the claims side of the business.

Written for both experienced and new insurance professionals, this book provides a comprehensive overview of how the claims process is handled, controlled, and managed, and its interrelationship with other functional departments.

Nonclaim professionals will gain a better understanding of how to improve profitability through effective technical claims handling and claim management (including proper caseloads) and recognize when and why a claims operation or TPA is not meeting industry quality standards.

Who Should Buy This Book: Adjusters, claim managers, TPAs, risk managers, underwriters, program managers, insurance agents, captive owners, captive managers, and attorneys.

Use this book as a training resource! Call IRMI Client Services at (800) 827-4242 for bulk order pricing.


Image of Michael MurdockMichael T. Murdock
Senior Vice President
Berkley Risk

Claims Operations: a Practical Guide covers these topics.

  • Introduction
  • Claims Operations Overview
  • Types of Claims Operations
  • Core Operational Issues
  • Claims Management Overview
  • Management Controls
  • Recruitment and Retention
  • Financing and Banking
  • Technology
  • Claims Process Overview
  • Investigation and Adjustment
  • Statements and Interviews
  • Coverage Issues
  • Evaluation and Resolution
  • Going to Court
  • Reserve Management
  • Recovery
  • Third-Party Administrators Overview
  • Operations
  • Legal and Regulatory Compliance
  • Claims Handling Guidelines Overview
  • Auto Physical Damage
  • Auto Liability
  • PIP/No-Fault
  • First-Party Property and Inland Marine
  • Cargo
  • General Liability
  • Professional Liability and Management Liability
  • Public Entity
  • Workers Compensation

Download Table of Contents

Claims Managers, Adjusters and Adjuster Trainees

  • Gain a better understanding of all claims operations and how the operations interrelate with other departments.
  • Learn the details of the variety of claims operations in different risk financing structures, such as captive insurance companies.
  • You'll be able to gauge the results of proper claims staffing on the claims operation, and the impact from utilizing an effective staffing model.
  • Understand the impact of reserve management on profitability or loss.
  • Takes the mystery out of third-party claim administration (TPA) operations.
  • New adjusters will receive a consolidated understanding of the claims process. Perfect for a claims trainee program.
  • Claims adjusters and claims managers will better understand each other's role in the claims process and their combined impact on results.

Claims Executives & Insurance Buyers

  • Achieve a balance between adequate adjuster caseloads and meeting budgetary constraints.
  • Understand the TPA pricing models and factors impacting pricing.
  • Learn how increased staffing with manageable caseloads can positively impact results with reduced loss costs.
  • Provide guidance with a "best practices" claim model.
  • Implement a best-in-class claims trainee program.

TPA Management

  • An excellent resource for understanding the TPA operations and their impact on the core services provided of technical claims handling and claims management.
  • Understand the effect of inadequate pricing on results and client retention.
  • See examples of adverse results from improper or inadequate staffing decisions.
  • Learn how improper claims handling can affect the financial stability of the company with errors and omissions and poor quality.

Insurance Agents, Brokers and Claim CSRs

  • Learn how claims investigations and reserves impact results.
  • Get the right questions to ask about claims operations and their impact on your agency.
  • Understand what is behind the loss run numbers and if the incurred losses are adversely affected by the claims operation.
  • Gain insight into whether the insured’s workers compensation experience modification factor is adversely affected by the claims operation.

Risk Managers

  • Outlines how to develop a company-owned claims facility to handle claims within self-insured retentions.
  • Understand how improper claims handling can affect the financial stability of the company.
  • Gain insight into whether the insured's workers compensation experience modification factor is adversely affected by the claims operation.
  • Learn how claims investigations and reserves impact results.
  • Provides a practical guide to which questions to ask during the selection process for insurers.


  • Learn how results are impacted by claims handling (re: loss ratios) and claims investigations as the basis for claims reserves.
  • Understand why adequate staffing is so important in a claims operation and how it impacts underwriting results.
  • Gain a better understanding of how claim reserves are established, including the evaluation basis for bodily injury case reserves.
  • Provides guidance for a "best practices" model.
Bonus Publication Icon

Your purchase of the online version of Claims Operations: a Practical Guide comes with a digital copy of the Fundamentals of Insurance Law. A comprehensive, 150-page overview of legal principles for risk and insurance professionals. Fundamentals of Insurance Law has 13 chapters addressing topics such as: insurance regulation, characteristics of contracts, the anatomy of an insurance policy, property law, legal liability, the legal environment for underwriting and claims adjusting, and consumer laws affecting insurance.

Online Access

IndividualSingle User

Small BusinessUnlimited Users

Large BusinessUnlimited Users

Print Copy

In addition to purchasing online access, you also have the option of purchasing a printed edition of this book for $139.

Add to Cart

Related Products

Blueprint for Workers Comp Cost Containment Book

Blueprint for Workers Comp Cost Containment

Filled with practical suggestions, this book supplies insight and solutions for controlling and even reducing workers compensation costs and premiums. It will pay for itself over and over again. Learn more.

How to Draft and Interpret Insurance Policies

How to Draft and Interpret Insurance Policies

A must-read for anyone in the insurance business, How to Draft explains the rules courts use when reading an insurance policy and offers practical suggestions for using definitions, punctuation, tabulation, sentence structure, and simplified prose to minimize ambiguity. Learn more.

Insurance for Defective Construction

Insurance for Defective Construction

Provides a detailed review of relevant coverage issues and how they have been treated by the courts. Includes detailed maps on the construction defects as occurrence issue. Learn more.


Social Media