Session 045: Operational Risk Management for Health Insuranceclosely follow federal law. The Sherman Act, is the primary U.S. antitrust law pertaining to association activities ... insurers, Blue Cross and Blue Shield plans, managed care organizations, regulators, and government agencies ...
Description: Enterprise Risk Management is often thought to be synonymous with managing an insurance company toward financial objectives with a focus on insurance-specific risks. Some might argue though that operational risks are the crux of all risks confronted by an insurance company and ultimately drive the company’s outcomes.Operational risk is the risk of impact on financial outcomes due to operational events, involving internal systems, personnel, procedures or controls, and also external events. Operational risk exists in all business activities, covering fraud, human error, accounting errors, legal actions and system failures. All of these activities could occur during the course of conducting day-to-day business operations. Additionally, insurance executives must consider the pace of change in the external environment and potential impacts on their business. This presentation is focused on operational risks, current and emerging, faced by health insurance companies.Hide
- Authors: Marc Lambright, Edward M Mailander, Rebecca B Scotchie
- Date: May 2019
- Competency: Strategic Insight and Integration
- Topics: Enterprise Risk Management>Operational risks; Health & Disability>Health insurance