The Research On Operational Risk Management Of Medical Insurance Bureau Of A City

Medical insurance is a part of social insurance,which is enforced by national legislation.Employers and employees pay premiums by a certain percentage to establish the medical insurance fund,which pays the medical expenses of employees in a certain range and a certain percentage.All the insured share the risk of a small number of the other members according to the law of large numbers,which is redistribution and transfer of personal income in essence,in order to achieve mutual aid and social stability goals.It is also to prevent the insured person poverty caused by illness,an important measure to maintain social harmony and stability.Medical insurance fund is the cornerstone of medical insurance,health insurance fund security is to maintain the lifeline of the normal operation of medical insurance.In recent years,China's medical insurance institutions around the increasing risk of operation,external fraud has occurred,the health insurance fund security caused a greater impact.Local medical insurance institutions from the operational point of view,through internal control and supervision and auditing and other means to prevent the loss of health insurance funds,affecting the rights and interests of insured institutions affect the strategic objectives of the negative factors.However,most of the operational risk management work of medical insurance institutions in various places is in the stage of initiation and exploration,and there is a lack of awareness of operational risk management in different degrees.The management of legal management is not clear,the operational risk management organization is not perfect,and operational risk management Technical unscientific,operational risk management information system is imperfect and so on.In this paper,we take Medical Insurance Bureau of A city as an example,through investigation and study,Medical Insurance Bureau of A city to manage the status of operational risk management to COSO risk management framework as the basis,selected the internal environment,objectives,risk assessment,control activities,information and communication,monitoring and other six elements for the evaluation of the object,through the Delphi method of Medical Insurance Bureau of A city operating risk management system in the evaluation of the integrity and effectiveness of the elements,found that Operational risk management awareness,operational risk management organization structure,operational risk identification and evaluation technology,operational risk management information system security,operational risk management results feedback and application,operational risk management supervision and evaluation mechanism and so on.After analyzing and analyzing the existing problems,this paper constructs the operational risk assessment model of the medical insurance institution by using the operational risk identification technology such as self-assessment method,causal analysis method and operational risk assessment technology combined with quantitative evaluation and qualitative evaluation.Medical Insurance Bureau of A city of various types of operational risk occurrence frequency,impact degree and so on,trying to find out the various types of operational risk mechanism and causes,thus revealing the operational risk behind the process design,internal staff management,information systems Construction,external fraud prevention and other aspects of the existence of problems.At the end of this paper,based on the analysis and evaluation of operational risk of Medical Insurance Bureau of A city,it is suggested that Medical Insurance Bureau of A city should adopt three kinds of countermeasures,such as risk prevention,risk reduction and risk transfer,according to its own characteristics,and put forward that we should learn from COSO enterprise risk management framework,Through the design,implementation,evaluation of three stages,the construction of Medical Insurance Bureau of A city operating risk management system,through the improvement of operational risk management of the internal environment,designated operational risk management objectives,reasonable designation of operational risk response program,continuous internal control work,improve the operation Risk management information construction,strengthen the operation of risk monitoring and evaluation and other measures to prevent operational risks,maintenance of health insurance fund to provide security.