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
I.
23.06.2025
- 24.06.2025
II.
17.11.2025
- 18.11.2025