Health Insurance and Managed Care: What They Are and How They Work, Fourth Edition by Peter R. Kongstvedt
Author:Peter R. Kongstvedt
Language: eng
Format: epub
Publisher: Jones & Bartlett Learning
Published: 2015-02-25T16:00:00+00:00
CHAPTER 6
Sales, Governance, and Administration
LEARNING OBJECTIVES
• Describe the basic structure of governance and management in payer organizations
• Identify the basic elements of the internal operations of payer organizations:
• Information technology
• Marketing and sales, including insurance exchanges
• Underwriting and premium rate development
• Eligibility, enrollment, and billing
• Claims and benefits administration
• Member services, including appeal rights
• Statutory accounting and statutory net worth
• Financial management
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