In person
Medical insurance: from underwriting to claims management
A two-day practical programme for staff of insurance companies in Iraq, delivered in Baghdad on 19 and 20 August 2026: the medical product from the inside, medical underwriting and pricing, loss ratio, provider networks, claims management and fraud detection.
Medical insurance is the fastest-growing line in the Iraqi market and the most technically complex: underwriting accounts meet the medical file, four parties have competing interests (insurer, insured, provider and claims administrator), and loss ratios climb quickly when technical control slips. Many companies enter the line with enthusiasm and then meet reality: optimistic pricing that drains the portfolio, loosely drafted provider contracts, claims paid without enough audit, and fraud that passes unnoticed.
This programme followed a free introductory workshop on medical insurance. The participants' message was clear: we want more, in more depth. So we built two full days that move from general concepts to practice: how do you underwrite and price a medical product, how do you manage the provider network and the relationship with claims administrators, and how do you process a claim from pre-approval to payment while catching fraud and abuse at every stage.
Who it was for: medical insurance and medical underwriting staff, claims and benefits staff, provider-relations staff for hospitals, laboratories, pharmacies and claims administrators, sales and production staff who want a deeper understanding of the product they sell, and new recruits who need a sound technical base.
How we trained: more than half the time went to exercises and real cases from the Iraqi and regional market. Participants worked on a real medical policy document, computed loss ratios for a simplified portfolio, and audited claims seeded with fraud indicators to find them for themselves. Each participant received an Arabic training manual with all templates and working papers, and a quick-reference card of medical insurance terms in Arabic and English. The programme closed with a short test and a Triangulum certificate of completion.
Programme
Day 1, 19 August: the product, underwriting and the provider network
- The medical product from the inside: individual and group covers, the benefits table, exclusions and waiting periods, and a critical reading of a real policy
- Underwriting and pricing: medical risk assessment, the medical questionnaire, group underwriting and the effect of group size, and the components of the premium
- Loss ratio as the portfolio's compass: computing and interpreting it, and a practical exercise reading a medical portfolio and deciding on renewal, repricing or declining
- The provider network: contracting with hospitals, laboratories and pharmacies, price lists and discounts, network tiers and their effect on the premium
Day 2, 20 August: claims and fighting fraud
- Claims management step by step: pre-approvals, direct billing versus reimbursement, technical audit of the claim, legitimate grounds for refusal and how to communicate them
- Claims administrators (TPA): what they do and when a company needs one, the service agreement and performance indicators, and monitoring a third party without losing control of the portfolio
- Fraud, waste and abuse: red flags on the provider side (inflated bills, phantom services, split invoices) and the insured side (identity substitution, hidden pre-existing conditions), practical controls, and real market cases
- Closing session: an end-to-end exercise from receiving a claim to the decision, the final test and certificates
What you take away
- Tell individual and group medical products apart and read a benefits table, exclusions and waiting periods with a technical eye
- Apply the basics of medical underwriting: risk assessment, the medical questionnaire, group underwriting and the factors that drive the price
- Compute and interpret the loss ratio and use it in renewal and pricing decisions
- Manage the relationship with the provider network: contracts, prices, discounts and network tiers
- Understand the role of claims administrators and monitor their performance with clear indicators
- Process a medical claim through its stages: pre-approval, technical audit and direct billing or reimbursement
- Spot the indicators of fraud, waste and abuse on both the provider and the insured side and limit them
How it went
Delivered in Baghdad on 19 and 20 August 2026 for staff of insurance companies operating in Iraq, as the practical follow-up to Triangulum's free introductory workshop on medical insurance. Two full days, in Arabic, with more than half the time spent on exercises: a real policy document, loss-ratio calculations on a simplified portfolio, and claims audited for planted fraud indicators. Participants who passed the closing test received a Triangulum certificate of completion. The next edition will be announced here and on our LinkedIn page.