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(4.8/ 5) 17 Reviews
Gain specialized expertise in combating fraud in cooperative health insurance, which represents the largest share of insurance premiums in Saudi Arabia. This program will provide you with knowledge of health insurance functions, the philosophy behind claims processing, and how to identify various forms of fraud—both internal and external.
(4.8/ 5)
17 Learner Rating
Health insurance in the Kingdom of Saudi Arabia represents the largest part of the gross written premiums, the largest number of insurance policies and clients and is exposed to the largest amount of fraud cases with billions of Saudi Riyals. This program is designed to provide participants with knowledge related to health insurance, its functions, the philosophy of claims, and identify the different forms of fraud in health insurance (internally or externally); which may be carried out by employees, medical service providers or clients. In addition to ways to combat fraud in health insurance claims and clarify the negative effects resulting from it.
Insurance
Compliance and Anti-Financial Crimes
Not Exist
Lecture
Brainstroming +2
Lecture
Brainstroming
Practical Implementation
Dialogue Teams
Pre Assessment
Post Assessment
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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.
Self Learning
Module 1: Health Insurance Claims Department
Module 2: An Overview of Health Insurance Fraud
Module 3: Combating Fraud in Health Insurance Claims
Module 4: Combating Fraud Policy in Health Insurance
Module 5: Detecting Health Insurance Fraud
Module 6: Health Insurance Anti-Fraud Regulation
Recognize the role of Claims Departments of the Cooperative Health Insurance in insurance companies in order to maintain their profitability.
Understanding the most common fraudulent practices in health insurance, whether during underwriting or when submitting claims, in order to reduce instances of fraud.
Know the rules and regulations to help identifying identification of suspicious fraudulent claims.
Understand the measures that can be taken to detect and investigate suspicious and fraudulent cases to reduce this phenomenon.
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