Claims Management in Health Insurance and Managed Care Course

OBJECTIVE
At the end of this training participants will be able to:
• List the steps in health insurance claims process
• understand the strategic positioning of claims management;
• identify the linkage between claims processing and customer relationship management
• identify the different categories of claims and financial management
• apply claims inventory control strategies
• describe common claims management problems and know how to avoid them
• contrast traditional and modern trends in claims management

CONTENT
• Claims: positioning, purpose, and opportunities
• Pre-authorizations and claims payment
• Claims Operations Management
• Health Insurance Claims: the process
• Types of Claims
• Organizational structure and staffing
• Claims Staffing Ratio
• Management of claims inventory
• Claims pending factors
• Types of reimbursement arrangements and claims management
• Claims Categorization
• Workflow design of claims processing
• Productivity and quality management
• Managing claims TAT
• The Functional link between the claims payment process and the authorization
• Claims coordination with other departments
• Claims business functions
• Common Claims management problems and how to avoid them
• Handling multiplicity of HCP fee schedules
• Claims processing and information technology
• Outsourcing claims processing
• Claims management and customer relationship management

METHODOLOGY
The training methodology integrates lectures, interactive discussions, collaborative group exercises, and illustrative examples. Participants will acquire a blend of theoretical insights and hands-on practical experience, emphasizing the application of learned techniques. This approach ensures that attendees return to their professional environments equipped with both the competence and self-assurance to effectively implement the acquired skills in their responsibilities.

DATE:
1ST BATCH: 25th – 28th Mar,2025
2ND BATCH: 5th – 8th Aug,2025
3RD BATCH: 25th- 28th Nov,2025