Post Graduate Diploma/Executive Diploma in Health Insurance Management (PGDHIM/EDHIM)

Health Insurance is a system of assurance to meet the contingencies of health care expenses. The important objective of Health Insurance is to provide protection against financial losses caused by unforeseen health problems. It requires huge number of professionals to meet demand of the insurance sector.

The objective of this program is to expose students to modern healthcare policies, including quality, application, and implementation. This program primarily focuses on healthcare industry and its various departments in health care and public health organizations. Individuals who complete the Health Insurance program will have a solid knowledge of healthcare management and a solid exposure to the latest health insurance policies.

Programmme Structure :

Module 1: Introduction to Health Insurance

• History & Evolution of Health Insurance
• Key Stakeholders: Insurers, Policyholders, Regulators
• Types of Health Insurance (Individual, Group, Government Schemes)
• Role of Third-Party Administrators (TPAs)

Module 2: Health Economics

• Basic Economic Concepts in Healthcare
• Supply & Demand in Health Insurance
• Cost-Benefit Analysis in Health Policies
• Economic Impact of Universal Health Coverage

Module 3: Health Insurance System – Policies & Operations

• Health Insurance Policy Structure
• Policy Design, Pricing & Premium Calculations
• Reinsurance in Health Insurance
• Claims Processing & Settlement Procedures
• Underwriting & Actuarial Role in Policy Development

Module 4: Health Insurance Products

• Individual vs. Group Health Insurance
• Critical Illness & Disease-Specific Plans
• Senior Citizen & Maternity Health Insurance
• Top-Up & Super Top-Up Plans
• Wellness & Preventive Health Insurance

Module 5: Legal and Regulatory Aspects of Insurance

• IRDAI Guidelines & Compliance
• Consumer Protection Laws & Policyholder Rights
• Fraud Prevention & Anti-Money Laundering in Insurance
• HIPAA, GDPR & Data Protection Regulations
• Ethical & Legal Challenges in Health Insurance

Module 6: Medical Underwriting – Principles and Practices

• Risk Assessment & Underwriting Guidelines
• Pre-existing Conditions & Exclusions
• Actuarial Principles in Underwriting
• AI & Data Analytics in Underwriting
• Underwriting Challenges in High-Risk Cases

Module 7: Risk and Claims Management

• Risk Identification & Mitigation Strategies
• Cashless vs. Reimbursement Claims Processing
• Claims Adjudication & Settlement Procedures
• Medical Fraud Detection & Prevention
• Customer Experience in Claims Management

Module 8: Medical Coding

• Basics of Medical Coding
• Coding Systems (ICD, CPT, HCPCS)
• Role of Medical Coding in Health Insurance
• Medical Billing & Claims Processing

Module 9: International Classification of Disease (ICD-10)

• Overview of ICD-10 Coding System
• ICD-10 Implementation & Compliance
• Medical Record Documentation & Accuracy
• ICD-10 in Claims & Fraud Detection

Module 10: Digitalization in Health Insurance

• Role of Technology in Health Insurance
• Key Health Insurance Software (PegaSystems, Oracle Insurance, Applied Rater, Audit Stream)
• AI & Machine Learning in Claims Management
• Blockchain & Smart Contracts in Health Insurance
• InsurTech Innovations & Automation

Module 11: Health Insurance in Global Markets

• Comparative Analysis of Health Insurance Models (US, UK, India, Europe)
• International Health Insurance Regulations
• Cross-Border Health Insurance Policies
• Role of Medical Tourism in Health Insurance

Module 12: Healthcare Provider Network Management

• Hospital Empanelment & Network Agreements
• Negotiation of Insurance Contracts with Healthcare Providers
• Cashless Treatment Procedures
• Coordination Between Insurers & Hospitals

Module 13: Actuarial Science & Data Analytics in Health Insurance

• Fundamentals of Actuarial Science in Insurance
• Predictive Modelling & Risk Scoring
• Data Analytics in Claims Processing
• AI & Big Data in Health Insurance Decision-Making

Module 14: Customer Experience & Marketing in Health Insurance

• Customer Expectations & Service Quality in Health Insurance
• Digital Marketing in Health Insurance
• Distribution Channels: Agents, Brokers, Online Platforms
• CRM & Customer Retention Strategies

Module 15: Case Study

Eligibility

Graduate in any discipline is eligible for our Post Graduate Diploma and Certificate Programmes. For Executive Diploma programmes and Professional Certifications, you need to have at least 1 year of work experience.

Programme Duration

The duration to complete this programme is 1 year (Post Graduate Diploma), 6 months (Executive Diploma).

Programme Mode

Registrations are currently open for regular and online both modes.

Programme Deliverables

A comprehensive study material for all the modules in hard copies ensuring the needs of the audience. The accompanying training material is appropriately aligned with the current Industry’s expectations.

• Assignments for all the programme modules for continuous evaluation and guidance.
• Interactive or online live sessions on all key areas of the programme giving all flexibility to the participants.
• Online classes for all the modules will be conducted on the weekends. Moreover, a doubt clearing session will also be scheduled before the examination.
• All the efforts are made by IGMPI faculty members to make the entire programme modules easily understandable.
• Assessment and evaluation for all the programme modules in order to enhance the levels of competencies and skills of the participants leading towards the objective of application in the job.
• At the end of each programme modules, the trainers shall obtain feedback from the participants using specially designed questionnaires.
• All learning and training delivery initiatives shall be conducted in English.

Examination & Certification

IGMPI follows a credit system based on all learning activities involved in studying for all PG Diploma, Executive Diploma and Certificate Programmes. Each of your modules is equal to 4 credits. To successfully complete the programme, you will have to earn all the credits assigned to your programme.

All the participants are obliged to timely submit completed assessment assignments (during the programme, usually after every module) and appear for an online exam at the end of the programme. After successful completion, the participants will receive a certificate of Post Graduate Diploma/Executive Diploma in Health Insurance by Centre for Health Management and Research (CHMR), IGMPI. For all the above-mentioned modules, Online Classes (Online mode) or face-to-face classes (Regular mode), elaborate programme material, self-assessment assignments would be provided by the Institute. Details get updated on the webpage as well.

Placement Assistance & Corporate Relations

The Institute has partnered with many organizations for providing with placement assistance to in its participants. Besides, it has a robust placement cell comprised of senior level Human Resources professionals and Talent Acquisition experts which maintains close links with business and industry. This cell is continuously engaged in promoting the employability of our participants and encouraging the concerned Human Resources department and Hiring Managers to recruit/hire our participants for their vacant positions. The efforts of our placement cell also include helping with professional resume writing & interview skills.

In recent months the Institute has witnessed more and more participation from professionals working with global healthcare like Acko General, Aditya Birla, Future Generali, Aegon Life, HDFC ERGO General Insurance Limited, BhartiAXA,Tata AIG,AEGON Life, ICICI Lombard, Star Health & Allied Insurance Company Limited, Bajaj Allianz ,General Insurance Company Limited, Oriental Insurance Company Limited, Care Health Insurance Company Limited, IFFCO Tokio General Insurance, Care Health Insurance, Magma HDI Health Insurance, etc. The IGMPI’s Corporate Resource Division actively recommends our students and training participants for various job requirements and specialized roles to Human Resource, Talent Acquisition as well as the heads of various departments in Pharmaceutical, Healthcare industries on regular basis.

Future Career Prospects of Health Insurance

Changing lifestyles are causing diseases with expensive and prolonged treatments. Health insurance helps cushion your family finances from unexpected large medical expenses. It helps meet various health needs be it based on the life stage of a person or a specific disease. Health Care Insurance professionals are involved in the business aspects of health care service delivery.

Duties vary and may include planning and coordinating department activities in personnel and staffing, purchasing, public relations, fund raising, accounting, and program evaluation. They develop and implement budgets, analyze all types of data, and assure compliance with regulatory agency requirements or others work in marketing, finance, insurance, and information systems in health care and related organizations. Work opportunities in insurance sector are enormous. Health care professionals can work as Administrative Officer, Assistant Administrative Officer, Development Officer, Insurance / Composite Agents, Insurance Surveyors, Actuaries, Insurance Underwriter, Investment Professionals.

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Programme Fee Details

For further enquiries, call or write to us on:
18001031071 (Toll Free -9:00 am to 5:30 pm IST-except on Central Government holidays)/ info@igmpi.ac.in