Health Insurance and Medical Scheme Administration
Claims are rejected and members are frustrated mainly through administrative failure rather than clinical dispute. This course covers benefit administration, claims processing and the controls that manage cost without denying valid care.
Course outline
What this programme covers, module by module.
- 01How medical schemes and benefit structures work
- 02Membership, dependants, contributions and waiting periods
- 03Claims processing against benefit rules
- 04Pre authorisation, managed care and clinical protocols
- 05Prescribed minimum benefits and mandatory cover
- 06Fraud, waste and abuse detection in claims
- 07Complaints, disputes and regulatory escalation
What you will gain
- Explain how medical scheme benefits are structured
- Administer membership, dependants and contributions
- Process claims accurately against benefit rules
- Apply pre authorisation and managed care protocols
- Detect and investigate fraudulent or abusive claims
- Handle member complaints and disputes fairly
Who should attend
- Medical scheme and insurance administrators
- Claims assessors and processors
- Hospital billing and case management staff
- Client service staff in health funding
Upcoming sessions
| Date | City | Duration | Fees | Book |
|---|---|---|---|---|
| 9 to 11 Nov 2026 | Durban | 3 Days | R13,000 | |
| 24 to 26 Nov 2026 | Cape Town | 3 Days | R13,000 | |
| 11 to 13 Jan 2027 | Johannesburg | 3 Days | R13,000 | |
| 8 to 10 Feb 2027 | London | 3 Days | US$1,500 | |
| 12 to 14 Apr 2027 | Dubai | 3 Days | US$1,500 | |
| 28 to 30 Jun 2027 | Pretoria | 3 Days | R13,000 |
Fees are per delegate and exclude VAT. Public intakes are confirmed once minimum numbers are met. We also deliver this course on your own schedule, in-house or live online.
Enquire about this course
Register your team or ask for a tailored in-house quote. We reply within one working day.
WhatsApp usCourse brochure (PDF)- Fees from
- R13,000 per delegate
- Duration
- 3 Days
- Field
- Healthcare & Hospital Management
- Formats
- In-house, public, online
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