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Register now to learn tools for combating fraud in health insurance claims.
3 Reviews
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
Claims
Health Operations +3
Claims
Health Operations
Internal Audit
Sales and Distribution / Intermediaries
Underwriting
Compliance and Anti-Financial Crimes
Not Exist
Lecture
Brainstroming +2
Lecture
Brainstroming
Practical Implementation
Dialogue Teams
Pre Exam
Post Exam
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- +3
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Purchase Program
( 0)Available
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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.
In Class Training-Online Training
The objectives and the importance of the Health Insurance Claims Department
Health Insurance Claims Department Organizational Structure
In Class Training-Online Training
The concept of health insurance fraud
Types of health insurance fraud
Examples and scenarios of fraudulent practices
In Class Training-Online Training
Fraud Definition
Internal and external fraud
Fraud Indications in health insurance claims
Combating fraud in health insurance claims
In Class Training-Online Training
Anti-fraud plan
Special Investigation Unit
Anti-fraud procedures
Cooperation with governmental agencies and insurance companies
Educating customers and service providers about the fraud risks
In Class Training-Online Training
Manual detection
Processing of electronic claims and fraud
Anti-fraud technology
Review files and records
Fraud reporting channels
Follow up on communications internally and externally
In Class Training-Online Training
Anti-fraud regulation from the Central Bank of Saudi Arabia
CCHI Anti-fraud Guidelines
Recognize the role of Claims Departments of the Cooperative Health Insurance in insurance companies in order to maintain their profitability.
Understand the most common fraudulent practices in health insurance, whether during underwriting, or submitting claims to reduce losses.
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.
