Claims Management Essentials: Cost-Saving Strategies for Employees and Employers

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Understand and master the various methods of medical claim reimbursements. This foundation is critical to understand health plan networks and how they function as the baseline for cost in fully insured and self-funded plans. This unit will expand on the previous unit's analysis of point solutions and how to build those into your plan design not only for the benefit if rate structures, but employees as well. The instructor will show you how to structure your medical plans to save the plan money by incentivizing the member through cost reduction programs.

Basic Course Information

Learning Objectives

• Describe the primary medical claim reimbursement methodologies, including how provider networks and reference-based pricing impact fully insured and self-funded plan costs.
• Explain key plan design principles and risk management strategies used to structure medical plans for cost control and financial sustainability.
• Identify strategies to incorporate point solutions and member incentive programs that reduce plan costs while improving employee engagement and outcomes.

Major Subjects

Claims