Explore Financial Academy
About the Academy
Discover our Rich, 60-Year Journey
Jadarat
A Comprehensive System for Skill and Knowledge Development
Governance
Meet our Inspiring Leadership
Success Stories
Check out our Clients’ Reviews and Testimonials
...
Register now to gain the knowledge and skills required for processing health insurance claims, identifying and defining risks, and evaluating them effectively
Claims Settlement of the Cooperative Health Insurance is one of the most important risk management and customer acquisition tools in the insurance sector. The program is designed to provide participants with the knowledge and skills to undertake the health insurance claims handling process including notification, assessment, settlement, financial factors, and associated legal background. It also reviews and estimates claims reserves, including Outstanding Reserves and IBNR.
Insurance
Actuary
Claims +5
Actuary
Claims
Customer Care
Health Operations
Internal Audit
Reinsurance / Retro Operations
Risk Management
Operations
Not Exist
Other
Lecture +2
Other
Lecture
Practical Implementation
Exercises and assignments
Pre Exam
Post Exam
-
- +5
-
-
-
-
-
-
-
Purchase Program
( 0)Available
To preview individual and groups discount policy, Click Here
This provides you with the opportunity to select the available times that suit you best for participation in our program. These times represent slots during which we are ready to welcome you and provide assistance and guidance.
In Class Training-Online Training
Definitions, Limitations, and Exclusions
General Conditions
Schedule of Benefit (SOB), and Appendixes
Unified Medical Declaration Form
Recoverable Expenses/ Benefits
In Class Training-Online Training
Legal Requirements of Claim Notification
Policy Requirements of Claims
Settling Claims based on Policy Condition
Duties of the insured when a Claim/Loss is incurred
Duties of medical services providers in medical insurance claims
Claim Supporting Documents
In Class Training-Online Training
Eligibility
Prior Authorization
Deductibles
Coinsurance
Copayment
Documentation
Electronic Claim
Medical Fraud
Invalid Claim
Partially Fulfilled Settlement
Final Review
Payment (Remittance)
Other Methods of Settlement
In Class Training-Online Training
Organizational Structure
Responsibilities of Claim Staff
Customer Service Standards: Fair Treatment and Managing Expectations
Claim Estimation
Reserve Allocation
Laws and Regulations
In Class Training-Online Training
Expense Management
Roles of the Claims Manager
Control of Operational Costs
Promoting Economically Effective Medical Care Services
Cost Sharing
Recover Claim Payments from a Third Party
Incentives for Cost-Effective Alternatives
Patient Referral Leakage/ Network Leakage: How to identify and reduce?
Types of Financial Control and their effect on the insurance company’s results
(Claim Management Software Solutions (Systems
Claims Management Company (Third Party Administrator)
Recognize the role of the health insurance claims department in the operations of insurance companies to maintain the profitability of companies.
Understand the health insurance claims operations cycle of data collection and analysis, handling claims and investigating claims to ensure that quality requirements are met.
Understanding of the regulations and procedures to ensure the identification of suspicious claims fraudulent for health insurance claims and identification of cases of claims Leakage.
The ability to manage relationships with stakeholders using the best negotiating practices relating to files and claims cases.
Identify how to Create a claim reserve, calculate the loss ratio and the role of reinsurance to control of catastrophic health insurance claims.
