Health Insurance Claims & TPA Operations Specialist
Master cashless hospital approvals, reimbursement auditing, medical fraud investigation, and TPA networks.
Transparent Fee Structure & Taxation
| Component | Amount (INR) | Applicability & Notes |
|---|---|---|
| 1. Base Program Tuition | ₹4,499 | Live practical training, LMS access, project reviews, and job interviews |
| 2. Screening Assessment & Capstone Fee | ₹999 | Proctored examination, score card, and interview evaluation |
| 3. Statutory GST (18%) | ₹990 | Government indirect tax with standard GST invoice issued |
| Total Payable Upfront | ₹6,488 | Paid via verified Razorpay portal after applying for assessment |
Curriculum Syllabus (4 Modules)
12 Total LessonsModule 1: Health Insurance Policy Architecture & Wordings
3 LessonsIndemnity vs fixed benefit policies, room rent capping, disease-specific sub-limits, and co-payment clauses.
- 1Deconstructing Standard Indian Health Policy Wordings & ExclusionsPreview38 min
- 2Room Rent Proration Mechanics & Proportionate Deductions42 min
- 3Pre-Existing Disease (PED) Waiting Periods & 36-Month Portability Norms40 min
Module 2: Cashless Hospitalization & Pre-Authorization Protocols
3 LessonsTPA workflows, hospital desk pre-auth requests, initial approval calculation, and discharge summary auditing.
- 1Processing Cashless Pre-Auth Request Formats within 1-Hour TAT45 min
- 2Audit of Emergency vs Planned Admission Eligibility36 min
- 3Interpreting Indoor Case Papers (ICP) and Doctor Progress Notes48 min
Module 3: Medical Billing Audit & Fraud Detection
3 LessonsIdentifying billing inflation, unbundled surgical charges, non-medical expenses (List I-IV), and phantom hospitalizations.
- 1IRDAI Non-Payable Items (List I to IV) Deductions Practice44 min
- 2Detecting Fraudulent Hospitalization & Inflated Pharmacy Invoices50 min
- 3Field Trigger Audits & Hospital Empanelment Compliance Inspection42 min
Module 4: Reimbursement Settlement & Final Capstone Project
3 LessonsAdjudicating post-discharge claims, querying discrepancies with insureds, and final claim approval computation.
- 1End-to-End Adjudication of a ₹4.5 Lakh Multi-Specialty Surgical Claim55 min
- 2Grievance Redressal, Ombudsman Presentations & Customer Support Scenarios45 min
- 3Capstone Proctored Health Claims Audit Examination90 min
Assessment & Certification Roadmap:
Submit profile, academic qualification, and choose examination slot.
Pay ₹999 exam fee via official Razorpay link and complete test.
Complete hands-on case studies, live mentor sessions, and capstone project.
Get verified credentials, resume audit, and interview deployment.