Medical Insurance Operations and Liability Training Course (Online / Remote)
1Summary
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.
2Objectives and target group
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.
3Course Content
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.