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

Participantsí 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:             12.01.2023-13.01.2023