Medical Insurance Underwriting and Claims

Course Description

This course is aimed at providing knowledge and skills that are required to handle the operations of medical insurance. It focuses on the design, function, management, regulation, and evaluation of health insurance underwriting. It also provides a firm foundation into understanding the various medical terms, the responsibilities of health insurance specialists, designing of health insurance products, provider selection, payment framework in health insurance and the underwriting procedure in relation to health insurance.

Course objectives 

The course will be guided by the following objectives:

1. To expose learners to the design, function and management of health insurance underwriting.
2. To familiarize learners with the terms used in health insurance. 
3. To describe the responsibilities of different health specialists and examine their relevance to health insurance operations.
4. To examine the regulatory framework that guides operations of the health insurance practices. 

Expected learning outcomes

Upon completion of this course, every learner should be able to:

1. Describe the concepts of medical insurance.
2. Identify the various risks in the health sector and also be able to appreciate the role of medical insurance in guarding against such risks.
3. Recognize the various medical insurance products.
4. Describe the underwriting procedure under medical insurance.
5.  Assess extent of the health risk and also be able to cost the likely damage.
6. Describe the regulatory framework that guides the medical insurance practices.

Further reading

Berkowitz, E. (2010). Essentials of health care marketing. Jones & Bartlett learning.

Boland, P. (1991). Making managed health care marketing. Jones & Bartlett learning.

Brown, M. (1994). Managed health care work: A practical guide to strategies, networks, and management. jones & bartlett learning.

Cleverly ,W., Cleverly, J & Song, P. (2010) Essentials of health care finance. jones & Bartlett learning.

Knight, W. (1997). Managed care contracting: a guide for health care professionals:. Aspen Publishers.

Knight, W. (1998). Managed care: what it is and how it works. Aspen Publishers.

Kongstvedt ,P., R. (2001). The Managed health care handbook. Jones & Bartlett learning

Mitchell, D. (1999). Managed care and developmental disabilities: reconciling the realities of managed care with the individual needs of persons with disabilities. high tides press.

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