National Insurance Academy, Pune|Insurance Technical (Non-Life)
P625 | Profitable Management of Health Portfolio (Non-Life)
Academic Year 2026-2027
Duration
3Days
Scheduled Dates
11 May 2026 - 13 May 2026
16 Sep 2026 - 18 Sep 2026
Background
Health insurance has emerged as the dominant business line within India's general insurance sector, now accounting for nearly 41% of the total premium portfolio. Rapid product innovation, expanding health infrastructure, the digitalization drive, and mass health schemes like PMJAY (Ayushman Bharat) have deepened market penetration and widened access. The inclusion of senior citizens under PMJAY and the growing appetite for retail and group covers indicate sustained high growth ahead.
Yet this growth story has a paradox - health insurance continues to be the largest contributor to underwriting losses. Managing profitability demands sharper pricing, disciplined underwriting, robust provider management, and tech-driven claims governance. As the ecosystem matures, the role of AI, Gen AI, data analytics, wellness models, and digital health platforms has become central to improving efficiency and customer experience while managing claims leakage.
Learning Objectives
This advanced programme enables participants to build strategic and operational capabilities for profitable management of health portfolios by enhancing their understanding of:
Emerging trends and drivers shaping the health insurance market.
Regulatory and policy frameworks influencing portfolio sustainability.
Principles of profitable underwriting and claims adjudication.
Use of data, analytics, and AI for precision underwriting and claims efficiency.
Product design innovation aligned with wellness, affordability, and profitability.
Key Contents
Understanding Profitability in the Health Business
Managing High-Frequency Disease Portfolios
Medical Adjudication and Clinical Validation of Claims
Product Innovation and Profitability Levers
Retail Health Underwriting and Risk Assessment
Provider Network Management and PPN Strategies
Group Health Insurance - Pricing and Portfolio Controls
Health Insurance Regulations and Market Conduct
PMJAY and Emerging Public Health Schemes
Technology, AI, and Gen AI in Health Insurance
Operational Interface with TPAs and Digital Health Platforms
Who Should Attend
Officials involved in health insurance underwriting, claims, and operations, and those seeking to strengthen strategic and analytical perspectives in managing the health line of business from carrier companies and intermediaries.
