Health Plan Finance And Risk Management (AHM520)



Get a comprehensive look at health insurance plan finance. You’ll learn about financial management techniques, funding, risk management, provider reimbursement, plan risk, pricing, underwriting, and rating methods.

What You’ll Learn

  • Learn about strategic planning and the role of strategic financial planning in setting the future direction of a health plan.
  • Gain an understanding of risk, decisions regarding risk assumption, and how health plans control risk.
  • Learn the difference between stop-loss insurance and stop-loss reinsurance from the insurance industry perspective.
  • Learn about the financial risk for health plans that provide healthcare service to the Medicare and/or Medicaid populations compared to the commercial population.
  • Learn how to distinguish between fully funded and self-funded plans and the increasing role of self-funding in the marketplace.
  • Learn how to identify claim related components of health plan financial statements.
  • Learn about different reserving methodologies used by health plans.

Who Should Take This Course

  • Employees who work for health care providers or health insurance plans and want to acquire the educational background to pursue a management position in the industry
  • Case managers and medical directors who seek a broader administrative background
  • Educators at the college level who teach health care administration
  • Financial planners, and agents and brokers who specialize in life and health insurance
  • Medical management staff working in hospitals, health systems, HMOs, health insurance plans, and PPOs
  • Consumers and others in related fields who seek expertise in this area


  • $220 AHIP Members
  • $280 Non-members

To enroll in a course, or purchase a text book, please log in, and browse our online catalog. If you are a new user, please register for an account to get started.

Earn a Designation

This course is good towards earning the following Academy for Healthcare Management designation:

Fellow, Academy for Healthcare Management (FAHM®)

Sponsored by America’s Health Insurance Plans and the Blue Cross Blue Shield Association, AHM relies on both associations’ decades of experience providing continuing education for health insurance plan professionals. AHM serves more than 1,300 health insurance plans caring for and providing coverage to more than 200 million people.

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