Health Plan Finance and Risk Management: AHM-520 Exam

"Health Plan Finance and Risk Management", also known as AHM-520 exam, is a AHIP Certification. With the complete collection of questions and answers, BraindumpsPass has assembled to take you through 215 Q&As to your AHM-520 Exam preparation. In the AHM-520 exam resources, you will cover every field and category in AHIP Certification Certification helping to ready you for your successful AHIP Certification.

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  • Updated on: Sep 17, 2026
  • No. of Questions: 215 Questions & Answers

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  • Updated on: Sep 17, 2026
  • No. of Questions: 215 Questions & Answers

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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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AHIP AHM-520 Exam Syllabus Topics:

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

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