PUNE
P746
- FRAUD ANALYTICS IN HEALTH INSURANCE (NON-LIFE)
Background:
Health insurance business while constituting the second largest
segment next to motor in the overall general insurance portfolio, also accounts
for significant percentage of the total claims outgo with frauds contributing to
10% to 15% leakage. Frauds result in losses for insurers impacting the bottom
line and affect the pricing of products with the customers having to pay higher
premium. Hence, it is important for
companies to have an effective fraud management program in place to control
claims, safeguard their assets and reputation.
Objectives:
The programme aims to equip participants with knowledge and understanding
of:
§
Fraud and
its implication for Health Insurance portfolio
§
Understanding
the power of analytics in insurance
§
Claim
analytics & fraud analytics - Impact on decision making.
§
Estimating
leakages in claims
§
Fine
tuning claims strategy
Contents:
§
Fraud and
its impact on Heath portfolio
§
Classification
of frauds
§
Identification
of key areas and pattern of fraud
§
Detection
of frauds - Fraud triggers / Red flags
§
Fraud in
health insurance underwriting & claims
§
Fraud
Investigation
§
Technology
and digital practices in fraud management
§
Fraud
analytics - Impact on decision making.
§
Collaboration
amongst stakeholder for exchange information on fraud
§
Role of
law enforcing agencies in curbing frauds
§
Creating a
framework for managing frauds
Participants’
Profile:
Officials handling Health Insurance; Officials in analytics
department in Head Office, Regional Offices, Operating Offices of Indian
and foreign public & private sector General Insurance Companies
Duration:
2 days
Dates:
02.05.2024 - 03.05.2024