Insurance

Health Insurance Claims & TPA Operations Specialist

Master cashless hospital approvals, reimbursement auditing, medical fraud investigation, and TPA networks.

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12 Weeks
Certificate of Completion
Instructor
Dr. K. S. Venkatesh, Senior Claims & Medical Underwriting Specialist
Download Course Syllabus (PDF)View all Insurance syllabi (PDF) →
Full Upfront Fee (All-Inclusive)
₹6,488Incl. 18% GST
Base Program Tuition:₹4,499
Assessment & Capstone Exam Fee:₹999
Statutory GST (18%):₹990
Total Payable Upfront:₹6,488
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Transparent Pricing • No Hidden Graduation or Certificate Surcharges

This course includes:

  • Real-world case studies
  • Expert instructor feedback
  • Downloadable resume templates
  • Verified Certificate
Download Complete Syllabus (PDF)

About This Course

A 10-week intensive specialized track covering cashless pre-authorizations, hospital empanelment, GIPSA preferred provider networks, ICD-10 medical coding basics, and claim dispute settlements under consumer forum guidelines.

Course Curriculum

Module 1: Health Insurance Policy Architecture & Wordings

3 lessons
Deconstructing Standard Indian Health Policy Wordings & Exclusions
Preview
Room Rent Proration Mechanics & Proportionate Deductions
Pre-Existing Disease (PED) Waiting Periods & 36-Month Portability Norms

Module 2: Cashless Hospitalization & Pre-Authorization Protocols

3 lessons
Processing Cashless Pre-Auth Request Formats within 1-Hour TAT
Audit of Emergency vs Planned Admission Eligibility
Interpreting Indoor Case Papers (ICP) and Doctor Progress Notes

Module 3: Medical Billing Audit & Fraud Detection

3 lessons
IRDAI Non-Payable Items (List I to IV) Deductions Practice
Detecting Fraudulent Hospitalization & Inflated Pharmacy Invoices
Field Trigger Audits & Hospital Empanelment Compliance Inspection

Module 4: Reimbursement Settlement & Final Capstone Project

3 lessons
End-to-End Adjudication of a ₹4.5 Lakh Multi-Specialty Surgical Claim
Grievance Redressal, Ombudsman Presentations & Customer Support Scenarios
Capstone Proctored Health Claims Audit Examination

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