What is meant by Health insurance management?
"Health insurance management" refers to the administration and organization of processes and data related to the billing and management of health insurance services. This includes handling premium payments, processing claims, managing insured individuals' data, and facilitating communication with policyholders and healthcare providers.
Typical software functions in the area of "health insurance management":
- Premium Management: Handling premium payments, including calculation of premium amounts, adjustments, and payment tracking.
- Claims Processing: Automated processing and billing of claims from policyholders, including invoice verification and cost reimbursement.
- Policyholder Management: Maintenance and updating of insured individuals' data, such as addresses, plan details, and insurance history.
- Communication Management: Supporting communication between the insurance company and policyholders, as well as healthcare providers, e.g., through automated notifications or a customer portal.
- Statistics and Reporting: Generating reports and statistics for analyzing premiums, claims, and overall business operations.
- Risk Management: Identifying and managing risks, such as monitoring claims expenditures or detecting fraud.
- Appeals and Complaints Management: Handling policyholder appeals and complaints, including tracking and documenting decisions.
- Contract Management: Managing contracts with healthcare providers and partners, including negotiations and contract monitoring.