Medical Insurance Course

The Medical Insurance Course is designed to strengthen participants’ expertise by providing a comprehensive understanding of medical insurance and healthcare fundamentals, along with the structure of the insurance market. It offers in-depth insights into underwriting processes, effective pricing strategies, and the key challenges involved in claims settlement, with practical approaches to resolving them. The course also highlights advanced techniques for detecting and preventing fraud in claims, explains the operational workflow within insurance companies, and delivers a clear overview of the regulatory framework governing the medical insurance sector under the new insurance law.

Targeted audience

Medical Insurance Specialist – Claims officer – Underwriting Officer – TPA Operations Officer

Medical Insurance Course Outline 

Day 1 Operations

• Medical Claims Management
• Approvals and Chronic Care Management
• Medical Network Management

Day 2 Underwriting and Pricing

• Underwriting and Pricing Methods and Mechanisms
• Operational Cost Control Techniques

Day 3

• Detection and Prevention of Fraud in Medical Insurance
• Cost Control

Day 4

• Regulatory Framework for Medical Insurance under Law No. 155 of 2024.
• Test

Course duration

16 Hours\ 4 Days