The highly specialized PG Program in Hospital Administration with specialization in Health Insurance and Third Party Administration (TPA) is designed to provide students with specialized knowledge and skills in managing health insurance operations, claims processing, and TPA services within the healthcare industry. According to market projections, the health insurance market size is set to reach $89.45 Bn and expected to grow at CAGR of 11.55% during the period from 2023 to 2030.. The health insurance market in India continues to experience significant growth and transformation, driven by various factors including rising healthcare costs, increasing awareness about health insurance, regulatory reforms, and the growing demand for healthcare services.

The PGPHA Program in Health Insurance and TPA will help the students to grasp the basic concepts and hone their skill sets in the following areas :

Health Insurance Fundamentals: The students will be introduced to the principles, concepts, and types of health insurance products and policies available in the market. They will learn about the structure of health insurance plans, coverage options, premium calculations, and policy terms and conditions.

Healthcare Financing: The enriched curriculum will covers various aspects of healthcare financing, including the role of health insurance in financing healthcare services, reimbursement mechanisms, fee schedules, and payment models such as fee-for-service, capitation, and bundled payments. The students will be trained to use the models as per the needs of different hospital and healthcare units to help them derive their viable economic models.

Regulatory Framework: The students will gain an understanding of the regulatory framework governing health insurance operations, including laws, regulations, and guidelines set by regulatory bodies such as the Insurance Regulatory and Development Authority of India (IRDAI) and other government agencies. This will help the students to understand the formation of new health insurance products launched by the insurance companies as well as viability of these products in the different sections of the society.

Health Insurance Administration: The program will aslo includes training in health insurance administration processes, including policy issuance, premium collection, claims processing, underwriting, and policyholder services. The students will also learn about the documentation requirements, workflows, and best practices for efficient insurance administration.

Third Party Administration (TPA): TPA's are important link in the healthcare ecosystem. The students in this course will learn about the role and functions of TPAs in healthcare delivery, including network management, claims adjudication, provider contracting, utilization review, and customer service. They will also study the regulatory requirements and accreditation standards for the different TPAs working across India as well as the international market.

Claims Processing: The course curriculum will covers claims processing principles and procedures, including claims submission, verification, adjudication, and payment. The students will learn about the coding systems (such as ICD-11 and CPT) used both in the Indian market as well as overseas market like the middle east (GCC countries) for claims processing and the importance of accuracy and compliance in claims adjudication using different softwares.

Fraud Detection and Prevention: This is emerging as one of the key areas as health insurance ecosystems involves several stakeholders including the government, both government and private hospitals, insurance companies, TPA and the patients. The course will acquaint the students with new insights into fraud detection and prevention strategies in health insurance and TPA operations. They will learn about common types of insurance fraud, red flags indicating potential fraud, and methods for detecting and investigating fraudulent activities using both theoretical as well as practical frameworks.

Customer Relationship Management (CRM): This special section in the PGPHA(Insurance and TPA) program will help the students to understand the impact of CRM upon businesses and business practice in the healthcare ecosystem by training them in CRM strategies and techniques for managing customer relationships in the context of health insurance and TPA services. Moreover, the students will learn about customer service standards, complaint resolution, and communication skills.

Healthcare Quality and Performance Metrics: In this course, the students will learn about quality assurance measures and performance metrics relevant to health insurance and TPA operations. The students will practically learn to use various software and understand key performance indicators (KPIs), benchmarks, and quality improvement initiatives aimed at enhancing service quality and efficiency in the field of claim processing and revenue management.

Emerging Trends and Technologies: Last but not the least, this unique tailor made curriculum will help the students to brainstorm and address the emerging trends and technologies shaping the health insurance and TPA industry, such as telemedicine, digital health platforms, artificial intelligence (AI), and data analytics. The Students at AIHMS will be encouraged to explore the potential impact of these new age innovations on insurance operations and service delivery.

Overall, this highly specialized program is aimed towards the beginners as well as mid career professionals in the health insurance and TPA sector to leverage their potential and honing their skill sets for exponential growth in their careers in health insurance companies, TPAs, hospitals, healthcare consulting firms, and government agencies involved in healthcare financing and administration.

After finishing the course, the graduates will be equipped with the knowledge, skills, and competencies needed to effectively manage health insurance operations, claims processing, and TPA services to ensure access to affordable and quality healthcare services for individuals and communities both at a national and international level.

So, If that appeals you, what you are waiting for...

Feel free to contact our HELPDESK NOW and make a flying career in the Health Insurance sector !!!