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Overview
Gain the knowledge and skills to pursue a management position in the health insurance industry or take the next step in growing your career. Across multiple courses, you’ll learn about managed care’s operational functions, organizational structures, administration, and regulatory environment.
Required Courses
To earn this career-driving professional credential, start by completing the following required online courses:
- Fundamentals of Health Insurance, Part A (Basics of Health Insurance)
- Fundamentals of Health Insurance, Part B (Basics of Company Operations)
- Health Management: An Introduction (AHM 250)
Electives
Then complete your choice of one of the following elective courses:
- Healthcare Insurance Advanced Studies, Part A
- Dental Benefits, Part A: An Overview of Dental Benefits and Dental Plans
- Fraud, Part I (Introduction)
Details of electives are available on request.Contact us at Training@iiea.co.ke
Learning Outcomes
On completion on this designation, you’ll gain a big picture understanding of the unique developments and trends that have shaped managed care as well as the policies, processes, and evaluation measurements that define quality.
Course Outline
- 1.1: Get the big picture: understand the importance of the life and health insurance industries
- 1.2: Develop a practical understanding of how health insurance works
- 1.3: Pinpoint the differences between types of coverage, including medical expense, supplemental, long-term care, and disability
- 1.4: Compare different types of health insurance provider organizations
- 1.5: Define the needs met by health insurance providers
- 1.6: Assess the advantages and disadvantages of flexible benefit plans
- 1.7: Explore contract provisions and how individual and group plans are underwritten
- 1.8: Learn how health insurance products are marketed and sold
- 1.9: Understand the role of reinsurance in promoting market stability and lower premiums
- 1.10: Define relevant terms and key concepts
- 2.1: Explore how group health insurance plans are administered
- 2.2: Understand the landmark health care reform initiatives that underpin the health care industry
- 2.3: Gain a solid foundation in policy issuance, installation, and the renewal process
- 2.4: Get up to speed on premium billing and payment
- 2.5: Learn how to manage, submit, and process claims
- 2.6: Identify best practices for controlling operational costs
- 2.7: Assess how health insurance providers promote cost-effective health care
- 2.8: Put the brakes of fraud and abuse: learn how to define, detect, and prevent it
- 2.9: Nail the concepts behind product pricing strategies
- 2.10: Learn how to navigate the regulatory process at the state and federal levels
- 2.11: Understand how advances in health information technology lead to improvements in health care quality and efficiency
- 2.12: Dive into the concept of medical homes and see how their focus on preventive care lowers costs
- 2.13: Learn the elements, implementation, and expected return from wellness programs
- 2.14: Pinpoint who buys and sells health care and at what pricing levels
- 2.15: Assess the government's role in advancing cost and quality transparency
- 3.1: Gain a practical understanding of the evolution of health care delivery and financing in the United States, from pre-paid plans to ACOs
- 3.2: Understand the basic concepts of health insurance provider organizations
- 3.3: Distinguish among HMOs, PPOs, POSs, and managed indemnity
- 3.4: Recognize HSAs' and HRAs' roles in today's consumer-centric environment
- 3.5: Identify different types of health insurance provider organizations
- 3.6: Learn the importance of network structure and management in delivering quality healthcare
- 3.7: Examine the interplay of information technology with essential functions of health insurance provider operations
- 3.8: Explore the concepts of rating, underwriting, and claims administration in health insurance provider environments
- 3.9: Delve into legislative and regulatory issues affecting the health insurance industry, including the Affordable Care Act (ACA) and the 21st Century Cures Act
- 3.10: Understand role of government-sponsored programs, including Medicare and Medicaid, in providing coverage to large segments of the population
- 3.11: Review relevant terms, industry issues, care scenarios, and concepts
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