Client Name

QLM Life & Medical Insurance Company

Faculty Advisor

Dr. Atizaz Ahsan

SBS Thought Leadership Areas

Investment Decision Making

SBS Thought Leadership Area Justification

This project is most aligned to one of the IBA SBS thought leadership areas, which is Investment Decision Making. By leveraging financial and operational data, the project aids in decision making by uncovering the cost drivers, risk exposures, leakage of claims, provider concentration, and savings potential. It assists management to assess where resources are being utilized, areas that needs control and the ways claims related decisions can enhance financial performance.

Aligned SDGs

GOAL 3: Good Health and Well-being

Aligned SDGs Justification

The project relates to efficient health insurance claim administration promotes improved access to healthcare services, increases the effectiveness of healthcare finance, and helps guarantee that resources are used appropriately within the healthcare system, it largely relates to SDG 3: Good Health and Well-Being.

NDA

No

Abstract

The purpose of this report is to provide an in-depth analysis of claims analytics and risk assessment that were performed on claims data for QLM Life & Medical Insurance, Qatar, to explore the key drivers of healthcare insurance costs, operational inefficiencies, opportunities for leakages and realizable opportunities for better monitoring and decision making. This project aimed to review the claims portfolio of QLM from January 2024 to December 2025, which consists of over 10.13 million lines, 275,018 members insured and approximately QAR 1.714 billion in net paid claims. The research design was quantitative and analytical, incorporating claims aggregation, year-on-year comparison, provider and doctor-level analysis, member and nationality segmentation, rejection-rate reconciliation, pre-authorization review, turnaround time assessment and actuarial reserve estimation. The financial analysis indicated that the IBNR reserve amounted to QAR 68.07 million, which was above internal standards and industry averages. The financial analysis showed that the claims turnaround time was 25.6days, which was higher than the internal standard and the industry standard. Overall, the project concludes that QLM is a well-established name in the health insurance industry of Qatar. However, they must apply a number of upgrades, including claims governance, the implementation of provider controls, which will be an even healthy pre-authorization framework, benefit caps in foreign countries, claims automation, and real-time monitoring systems, to make their performance viable. This report estimates that QAR 35 to 50 million could be saved annually by achieving optimal implementation of these recommendations

Document Type

Restricted Access

Document Name for Citation

Experiential Learning Project

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