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所在平台: Udemy |
课程主页: https://www.udemy.com/course/basic-claim-assessment-for-day-in-hospital-benefits/
课程评论：没有评论
课程名称：住院每日福利的基本索赔评估 课程概述：您是一名与医疗/健康相关产品工作的索赔评估员，或者希望进入这一领域吗？您是否想扩展对医疗/健康索赔的知识，尤其是如何评估每天因住院而支付的福利索赔？本课程将为您提供评估此类索赔的洞见，帮助您识别和验证可疑索赔，从而有效预防潜在的欺诈行为。 本课程的主要内容包括： - 有效索赔评估的必要性 - 欺诈行为产生的原因 - 相关医疗保险产品的欺诈趋势 - 如何验证诊断、治疗和住院信息 - 医疗文件在索赔过程中的重要性 此外，课程中还提供了实际案例研究，讲述我曾审核的真实住院记录和进行的调查，以展示如何利用上述知识有效评估索赔，识别可疑索赔，从而为拒绝索赔奠定基础。索赔评估员是打击保险欺诈的第一道防线，他们负责防止保险产品的滥用，发现欺诈行为，识别差异并提出问题。这项技能和能力可以通过加深对保险索赔评估的理解而学习，这将有助于您的职业发展，提高您作为医疗索赔评估员的自信，并让您在同行中脱颖而出。 此外，我还为此次课程增加了一些额外视频，以增强和深化学习。这些内容包括： 1. 针对与COVID-19相关的入院索赔的红旗评估标准 2. 关于以前一项涉及大规模医疗欺诈的国有企业调查的讨论，包括文件篡改和虚假入院的案例。 希望通过本课程，您能掌握评估索赔的知识与技巧，为您的职业发展助力。
Are you a claims assessor that works with or wishes to work with medical / health related products? Do you want to broaden your knowledge base about or gain insight into medical / health related claims? Specifically how to assess claims that for a benefit that will pay out for every day that the insured client is admitted? This is the course for you!This course is designed to equip you with insight into how to assess and therefore red flag and verify these types of claims and ultimately to prevent the payment of potentially fraudulent claims by learning about: Why effective claims assessment is necessaryThe reasons that fraud is committed Current trends in fraud related to the above mentioned insurance products How to verify diagnosis, treatment and hospitalizationsUsing medical documents as an integral part of the claims processI also provide case studies of actual, real life admissions I have reviewed and giving expert opinion on as well as investigations I have performed in the past to demonstrate how to use the above knowledge to assess your claims effectively and red flag suspicious claims and potentially form a basis for repudiation or rejection of the claimClaims assessors are the first line of defense against insurance fraud, they are the gate keepers that prevent abuse of insurance products and detect fraud by spotting discrepancies and asking questions. The skill and ability to do this can be learned as your deepen your insight into the assessment of insurance claims This will help you in your career and build your confidence as a medical claims assessor and allow you to stand out among your peers. PLUS!I have added some EXTRA videos for enhanced and deepened learning to this course to take your knowledge to the next level. These include: 1. Extra: Criteria for red flagging claims for admissions related to COVID 19 2. Extra: A discussion on a previous parastatal investigation related to massive medical fraud including document tampering and falsification of admissions
