Q. Who is the first stakeholder in the claims process?

View solution

Q. What is the role of underwriters in the claims process?

View solution

Q. Who is responsible for maintaining order in the insurance environment and protecting policyholders' interests?

View solution

Q. What is the purpose of reserving in the insurance industry?

View solution

Q. Which stakeholders may have conflicting objectives related to claims management?

View solution

Q. Who among the following is not a stakeholder in Health insurance claim process?

View solution

Q. What is the purpose of the claim intimation process in health insurance?

View solution

Q. When is it typically required to provide claim intimation for a planned hospitalization?

View solution

Q. What is the purpose of the registration process in health insurance claims?

View solution

Q. In case of deficiency in claim documents, how should the insurer communicate with the claimant?

View solution

Q. What are the factors that decide the claim amount payable in health insurance?

View solution

Q. What are "Reasonable and Customary Charges" in the context of health insurance claims?

View solution

Q. How is the claim payment typically made in health insurance?

View solution

Q. What percentage of health insurance claims are usually found not to meet the policy terms?

View solution

Q. What should the insurance company do if it denies a claim?

View solution

Q. What is the primary purpose of cashless settlement in health insurance?

View solution

Q. How does the cashless facility work in health insurance?

View solution

Q. In the cashless settlement process, what is the role of the Third Party Administrator (TPA)?

View solution

Q. What should a health insurance customer do if they don't have their insurance details with them when seeking treatment?

View solution

Q. Why should a health insurance customer check if the hospital suggested by their consulting doctor is in the network of the TPA?

View solution