Localization and Management of Health Insurance Accounts in Public Healthcare

Introduction

In the face of rapid developments in the healthcare sector and the growing demand for high-quality public healthcare services, efficient financial management of health insurance accounts has become crucial. This course is designed to equip financial and administrative professionals with the skills required to effectively manage health insurance financial operations within the public health sector. Emphasizing localization management—including Saudization/Nationalization—the course also aims to enhance national capabilities to drive financial sustainability and improve service quality for beneficiaries.

Course Objectives

By the end of this health insurance management course, participants will be able to:

• Understand the general framework of health insurance in the public sector, including types of health insurance and public healthcare policies.
• Professionally manage insurance accounts linked to healthcare services in a systematic manner.
• Develop an integrated financial system that connects medical services, budgets, and claims.
• Apply localization management principles effectively in financial operations, supporting nationalization efforts.
• Prepare accurate financial reports that enhance decision-making and support public healthcare policies.

Course Outlines

Day 1: Basic Concepts of Health Insurance and Public Health Financing

• Introduction to health insurance systems and their role in public healthcare.
• Differences between public option healthcare and private health insurance.
• Understanding healthcare financing models and their impact on public health policies.
• The role of the public sector in delivering insured health services and supporting healthcare public policy.

Day 2: Medical Cost Analysis and Linking to Financial Accounts

• Classification and documentation of medical services.
• Analysis of health service costs and their integration with insurance accounts.
• Effective billing management and insurance claims processing.
• Techniques for monitoring and analyzing medical spending to improve public healthcare efficiency.

Day 3: Localization of Financial Management in Health Insurance

• Key concepts of localization management in financial operations.
• Strategies to build national competencies in health insurance business and financial localization.
• Automation of financial systems and leveraging modern localization management systems.
• Real-world case studies and successful models in public healthcare localization.

Day 4: Claims Management and Financial Auditing in Health Insurance

• Understanding the insurance claims cycle from service provision to reimbursement.
• Establishing policies and procedures for financial review and compliance with public healthcare policies.
• Techniques for financial and technical auditing of insurance claims.
• Addressing common challenges in claims management and implementing best practices.

Day 5: Financial Reporting and Decision-Making

• Identifying types of financial reports essential for the health insurance sector.
• Understanding Key Performance Indicators (KPIs) — both financial and operational — for effective evaluation.
• Utilizing financial reports to enhance performance and support healthcare public relations and decision-making.
• Final Workshop: Design an integrated model for managing health insurance accounts within a public healthcare institution.

Why Attend This Course: Wins & Losses!

• Master Financial Management: Learn to manage health insurance financial operations effectively, ensuring compliance and sustainability.
• Localization Expertise: Understand the importance of localization management and its impact on public healthcare.
• Cost Analysis & Budgeting: Develop skills in medical cost analysis and budget planning for public health services.
• Financial Reporting Excellence: Gain expertise in producing accurate financial reports that drive effective decision-making.
• Real-World Application: Apply knowledge through real-world case studies and hands-on workshops designed to mimic public health financial operations.

Conclusion

This course is a crucial step for professionals seeking to excel in managing health insurance financial accounts within the public sector. By combining theoretical knowledge with practical application, participants will develop critical skills in financial analysis, planning, automation, and localization management. These competencies are essential to meet modern challenges and drive sustainable development in public healthcare finance.

Participants will leave equipped to implement robust financial management systems, aligned with public healthcare policies, that ensure financial sustainability, service quality, and compliance with localization strategies.