Important Points for IC 27 - Health Insurance Exam
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The insurance regulator has set up a policyholder information database- Insurance Information Bureau(IIB). The database could provide output on the lines of the Credit Information Bureau which caters to the banking industry.
Fraud detection mechanisms have to be robust and effective in eliminating any attempt to defraud the company.
Claim settlement is the ultimate testimony for any insurance company and therefore larger care is taken at underwriting stage so that claim settlement is done with ease.
Internal frauds are those perpetrated against an insurance company or its policyholders by agents, managers, executives, or other employees.
External fraud schemes are directed against a company by individuals or entities as diverse as medical service providers, policyholder, beneficiaries, medical consumable vendors etc.
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