AHIP AHM-520 exam dumps : Health Plan Finance and Risk Management

  • Exam Code: AHM-520
  • Exam Name: Health Plan Finance and Risk Management
  • Updated: Aug 20, 2026     Q & A: 215 Questions and Answers

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About AHIP AHM-520 Exam

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Health Plan Finance and Risk Management AHM-520 Exam

Health Plan Finance and Risk Management AHM-520 Exam is designed by the Academy of Health Care Administration (AHM) and sponsored by the US Health Insurance Plans and the Blue Cross Blue Shield Association. AHM is a self-study examination based program. AHM-520 Exam validates candidate has the ability to get a comprehensive look at the Health Insurance Plan Fund. This exam also verifies the candidate has a strong understanding of financial management techniques, funds, risk management, provider payment, project risk, pricing, care, and rating methods.

Reference: https://www.ahip.org/courses/health-plan-finance-and-risk-management-ahm520

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How to book the AHM-520 Exam

These are following steps for registering the AHM-520 exam. Step 1: Visit to AHIP Exam Registration Step 2: Signup/Login to AHIP INSURANCE EDUCATION account Step 3: Search for AHM-520 Exam Certifications Exam Step 4: Select Date, time and confirm with payment method

AHIP AHM-520 Exam Syllabus Topics:

SectionObjectives
Topic 1: Actuarial Principles and Forecasting- Actuarial concepts
  • 1. Reserve estimation
    • 2. Cost projection
      - Forecasting methods
      • 1. Financial planning
        • 2. Scenario modeling
          Topic 2: Regulatory and Compliance Framework- Healthcare regulations
          • 1. Affordable Care Act requirements
            • 2. State insurance regulations
              - Governance and reporting
              • 1. Compliance oversight
                • 2. Regulatory reporting
                  Topic 3: Provider Payment Models- Traditional and alternative reimbursement
                  • 1. Fee-for-service
                    • 2. Capitation
                      - Value-based payment
                      • 1. Shared savings arrangements
                        • 2. Financial incentives and provider risk
                          Topic 4: Health Plan Financial Structures- Revenue sources and premium development
                          • 1. Administrative and medical cost allocation
                            • 2. Premium setting principles
                              - Financial reporting
                              • 1. Financial statements
                                • 2. Performance measurement
                                  Topic 5: Risk Assessment and Risk Management- Risk mitigation strategies
                                  • 1. Predictive modeling
                                    • 2. Risk adjustment
                                      - Risk identification and evaluation
                                      • 1. Operational and financial risk
                                        • 2. Insurance risk
                                          Topic 6: Medical Loss Ratio and Compliance- Compliance requirements
                                          • 1. Rebate requirements
                                            • 2. Reporting obligations
                                              - Medical Loss Ratio concepts
                                              • 1. Regulatory thresholds
                                                • 2. MLR calculation
                                                  Topic 7: Claims Analysis and Utilization Management- Claims data analysis
                                                  • 1. Cost drivers
                                                    • 2. Trend analysis
                                                      - Utilization management
                                                      • 1. Cost containment strategies
                                                        • 2. Efficiency improvement

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