Running a medical insurance file well takes more than issuing a policy — claims teams and program managers need to price coverage accurately, negotiate contract renewals, and catch the errors that quietly drain a portfolio's profitability.

Coverage terms differ widely: some policies run for a fixed short period with no guaranteed renewal, while others sit inside a broader life insurance plan, and benefits shift with both duration and the insured's age. This training course builds the practical skills behind these decisions — preparing medical insurance programs, planning contracts, calculating premiums, and, just as importantly, recognising the mistakes and fraud patterns that medical insurance departments run into most often.

Target Audience

• Managers responsible for insurance and social insurance functions.
• Employees of the medical insurance department at insurance companies and service providers.
• Anyone working in a medical insurance department across any institution.

Program Objectives

• Handle issuances, claims, and day-to-day medical insurance correspondence.
• Manage the full medical insurance file, including contract renewal negotiations.
• Distinguish between types of medical insurance and their coverage terms.
• Work with medical service providers and understand the medical network.
• Apply Saudi Arabia's standards for managing medical insurance programs.
• Calculate premiums, control medical expenses, and structure financing.

Module 1: Issuances, Claims, and Daily Correspondence

• Managing and planning medical insurance contracts.
• Issuances, claims, and correspondence workflows.
• Claims examination and calculation methods.

Module 2: Building and Pricing Medical Insurance Programs

• Developing medical insurance programs and setting deductibles and cost-sharing rates.
• How to calculate medical insurance premiums and the key factors influencing the insurer's decision.
• Managing medical expenses, premiums, and financing, including self-funded health insurance funds.

Module 3: Types, Terms, and Legal Foundations

• Insurance foundations and key terms, and the medical insurance law.
• Types of insurance and types of medical insurance policies.
• Continuous and permanent medical insurance coverage, and recent changes in insurance contracts.

Module 4: The Medical Insurance Ecosystem

• Medical service providers and the medical network.
• Healthcare systems and how insurance companies deal with insured individuals.

Module 5: Personal Accident Coverage

• The personal accident policy: definition, importance, and its relation to medical accidents.

Module 6: Fraud Detection and Risk Control

• Identifying common fraud methods in medical insurance and how to detect them.

Module 7: Background and Practical Applications

• An overview and history of medical insurance development.
• Medical insurance procedures, and the benefits and objectives expected from this course.
• Applied case studies in medical insurance.