Advanced Medical Insurance Management Training Course

Name: Advanced Medical Insurance Management: Finance, Underwriting, and Audit
Availability: InStock

Master technical underwriting, IFRS 17 claims reserving, and medical audit controls for healthcare payers and providers.

Advanced Medical Insurance Management Training Course

At a glance

Duration: 1 Week
Format: Classroom
Cities: Chicago, London, Milan, Abu Dhabi, Baku, Nice and more
Next session: 18 – 22 October 2026, Chicago
Average fee: 5,800 €

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Advanced Medical Insurance Management: Finance, Underwriting, and Audit

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Overview

Rising claim costs, underwriting volatility, and complex clinical billing models challenge healthcare payers and provider networks. This programme delivers practical methodologies for advanced medical insurance management across underwriting, technical accounting, and claims auditing. Participants master risk pooling calculations, IFRS 17 actuarial reserving, medical loss ratio tracking, clinical coding audits, and fraud waste and abuse detection mechanisms. Professionals leave with actionable underwriting rating templates, claims adjudication protocols, and clinical audit checklists. This course is delivered by Agile Leaders Training Center.

Who Should Attend

Underwriting managers responsible for group medical scheme pricing, risk profiling, and policy terms design.
Finance professionals responsible for claims reserving, technical accounting, and solvency monitoring.
Claims audit specialists responsible for detecting billing anomalies, fraud, and medical necessity non-compliance.
Healthcare provider contract managers responsible for fee-for-service tariffs and value-based reimbursement agreements.
Actuarial analysts responsible for loss ratio modelling, portfolio experience analysis, and reinsurance allocation.

Departments and Industries

This course serves finance, clinical, and underwriting teams across health financing and hospital administration sectors.

Medical Underwriting Units in Commercial Health Insurance Companies
Financial Planning and Reserving Teams in Reinsurance Corporations
Revenue Cycle Management Departments in Tertiary Hospital Networks
Claims Review and Adjudication Divisions in Third-Party Administrators
Employee Benefits and Wellness Groups in Corporate Enterprises

Learning Objectives

By the end of this course, participants will be able to:

Apply risk-adjusted pricing models to evaluate group medical insurance loss experience.
Calculate technical reserves using chain-ladder and Bornhuetter-Ferguson actuarial methods.
Analyse healthcare provider billing patterns using clinical coding audit protocols.
Evaluate reinsurance treaty structures using quota share and stop-loss retention limits.
Diagnose fraudulent claims submissions using statistical anomaly detection rules.
Build financial dashboards to monitor medical loss ratios and combined operating ratios.

Course Agenda

Day 1: Underwriting Governance and Medical Risk Pricing

Group Risk Assessment using Community Rating and Experience Rating Frameworks
Demographic Morbidity Adjustments using Age-Sex Factor Weighting Models
Benefit Design Optimization using Deductible and Co-Payment Sensitivity Tables
Chronic Disease Exposure Sizing using Diagnostic Cost Group Profiling
Medical Underwriting Guidelines using Evidence-Based Risk Selection Protocols

Day 2: Health Insurance Accounting and Technical Reserving

Measurement of Insurance Contracts using IFRS 17 Fulfilment Cash Flow Models
Incurred But Not Reported Reserving using Chain-Ladder Run-Off Triangles
Ultimate Loss Estimation using Bornhuetter-Ferguson Actuarial Methods
Capital Adequacy Assessment using Risk-Based Capital Solvency Frameworks
Portfolio Performance Tracking using Medical Loss Ratio and Expense Ratio Dashboards

Day 3: Reinsurance Structures and Risk Transfer Strategies

Catastrophic Risk Protection using Excess of Loss Treaty Mechanics
Capacity Management using Proportional Quota Share Reinsurance Agreements
High-Cost Claim Mitigation using Specific and Aggregate Stop-Loss Structures
Reinsurer Counterparty Evaluation using Credit Risk and Solvency Matrices
Treaty Pricing Assessment using Burning Cost and Exposure Rating Models

Day 4: Claims Adjudication and Medical Audit Controls

Pre-Authorization Workflow Design using Clinical Pathway Utilization Reviews
Billing Accuracy Verification using ICD-10-AM and CPT Coding Standards
Unbundling and Upcoding Detection using Automated Rule Engine Logic
Medical Necessity Determination using InterQual and Milliman Care Guidelines
Post-Payment Provider Auditing using Stratified Statistical Sampling Plans

Day 5: Fraud Detection and Portfolio Governance

Fraud, Waste, and Abuse Investigation using Anomaly Scoring Algorithms
Provider Payment Integrity Governance using Special Investigation Unit Charters
Value-Based Contracting Evaluation using Bundled Payment Performance Metrics
Combined Operating Ratio Analysis using Financial Variance Models
Capstone Integrated Medical Portfolio Underwriting and Audit Simulation

Practical Exercises

Participants complete hands-on activities to resolve operational challenges and build execution plans.

Suggested activity: Build an experience-rated pricing sheet for a corporate group medical portfolio.
Suggested activity: Calculate IBNR claims reserves using historical development triangulations.
Suggested activity: Audit a batch of hospital claims to identify coding unbundling and billing anomalies.
Suggested activity: Construct an executive dashboard tracking medical loss ratios and audit recoveries.

FAQs

How does this course address financial accounting standards?

The sessions cover liability measurement, contractual service margin tracking, and claims reserving methods aligned with IFRS 17 principles, alongside risk-based capital solvency modeling.

What clinical coding standards are referenced during audit sessions?

Auditing exercises use established diagnostic and procedural coding classifications, including ICD-10-AM and CPT, to verify billing legitimacy and identify unbundling practices.

Who benefits most from the underwriting and actuarial modules?

Underwriting managers, actuarial analysts, and finance teams benefit directly from quantitative pricing models, experience rating exercises, and portfolio risk mitigation frameworks.

Conclusion

Participants return to their organizations equipped with practical frameworks to evaluate underwriting exposure, calculate accurate technical reserves, and conduct rigorous medical claims audits. By aligning risk-adjusted pricing with robust claims integrity controls, professionals safeguard balance sheets, prevent revenue leakage, and sustain profitable healthcare financing operations.

credits: 5 credit per day

Course Mode: full-time

Provider: Agile Leaders Training Center

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Showing 41-60 of 74 events

Location	Dates	Duration	Mode	Price
Zoom	Week 19, 2027 10 – 14 May 2027	1 Week	Online	€1,500
Berlin	Week 19, 2027 10 – 14 May 2027	1 Week	Onsite	€5,700
Paris	Week 20, 2027 17 – 21 May 2027	1 Week	Onsite	€5,700
Abu Dhabi	Week 20, 2027 17 – 21 May 2027	1 Week	Onsite	€4,700
Dubai	Week 21, 2027 24 – 28 May 2027	1 Week	Onsite	€4,500
Tashkent	Week 21, 2027 30 May – 3 June 2027	1 Week	Onsite	€4,500
London	Week 23, 2027 7 – 11 June 2027	1 Week	Onsite	€5,700
Istanbul	Week 24, 2027 14 – 18 June 2027	1 Week	Onsite	€4,500
Geneva	Week 24, 2027 20 – 24 June 2027	1 Week	Onsite	€6,200
Barcelona	Week 26, 2027 28 June – 2 July 2027	1 Week	Onsite	€5,700
Porto	Week 26, 2027 28 June – 2 July 2027	1 Week	Onsite	€5,700
Bali	Week 26, 2027 4 – 8 July 2027	1 Week	Onsite	€5,700
Vienna	Week 27, 2027 5 – 9 July 2027	1 Week	Onsite	€5,700
Bangkok	Week 27, 2027 11 – 15 July 2027	1 Week	Onsite	€6,000
Seoul	Week 28, 2027 12 – 16 July 2027	1 Week	Onsite	€10,000
Rome	Week 29, 2027 19 – 23 July 2027	1 Week	Onsite	€5,700
Trabzon	Week 29, 2027 25 – 29 July 2027	1 Week	Onsite	€6,800
Prague	Week 30, 2027 26 – 30 July 2027	1 Week	Onsite	€6,000
Madrid	Week 31, 2027 2 – 6 August 2027	1 Week	Onsite	€5,700
Lisbon	Week 31, 2027 2 – 6 August 2027	1 Week	Onsite	€5,700

Frequently asked questions

What does this course cover?

OverviewRising claim costs, underwriting volatility, and complex clinical billing models challenge healthcare payers and provider networks. This programme delivers practical methodologies for advanced medical insurance management across underwriting, technical accounting, and claims auditing. Participants master risk pooling calculations, IFRS 17 actuaria…

Are training dates available?

Yes. Available dates and destinations are listed in the course dates section on this page.

How can I register?

Choose an available date on this page and complete the registration form, or send a programme enquiry.

Can I download the course brochure?

Yes. Use the brochure download link provided on this page.

Advanced Medical Insurance Management Training Course