Medical Insurance Management Training

This course offers an overview of the medical terms, concepts, and language generally used in clinical practice settings. Classes in word construction and definition, pronunciation, Latin language roots, and spelling are designed to provide students with a fundamental knowledge of human anatomical names, diagnostic terms and medical procedures. The course is typically offered at the beginning of the program.

At the end of this course the participants will be able to:

• Introduce participants to types of health insurance.
• Introduce participants to medical and medical providers.
• Define the participants in issuing and claims management.
• Manage health insurance file.
• Negotiate the renewal of contracts with health insurance.
• Define health insurance contracts and various coverage

COURSE CONTENT:

Introduction:

• Insurance providers.
• Origin of insurance and risk management.
• Objectives and benefits.
• Insurance terms and principles of insurance.

Medical Insurance:

• Types of insurance.
• Health insurance law.
• Types of health insurance policies.
• Permanent health insurance cover.
• Preparation of health insurance programs.
• Overpayments and Endurance Rates.

Management of Medical Insurance Contract:

• Health Insurance Correspondence.
• Versions and Claims.
• Management of medical expenses and management of premiums and finance.
• Self-financing funds for health insurance.
• Claims and methods of calculation.
• Method of calculating the health insurance premium and the most important factors affecting the insured’s decision insurance company.
• Medical Services.

Technical Study of Medical Insurance:

• Introduction to the health care delivery system.
• Coverage in health insurance.
• Negotiate the renewal of contracts with health insurance.

Personal Accident Document and its Importance for Medical Insurance Contract:

• Definition of personal accident document.
• Coverage of personal accident document.
• Linking personal accidents to medical records.

Disclosure of Fraud in Medical Insurance:

• Disclosure of fraud in medical insurance.
• Fraud Detection Methods.

TRAINING METHODOLOGY

The training methodology combines lectures, discussions, group exercises and illustrations. Participants will gain both theoretical and practical knowledge of the topics. The emphasis is on the practical application of the topics and as a result participant will go back to the workplace with both the ability and the confidence to apply the techniques learned to their duties.