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Medical Aid Fund Administration

Fund Administration

  • Fund performance and reporting
  • Maintaining accounting, books and records of the schemes
  • Management of solvency margins

Claims Management

  • Receipt, auto assessment, adjudication, processing and payments of all the (paper, faxto email, & EDI) from healthcare service providers and members
  • Ensuring all claims are processed per scheme/ Fund Rules and in keeping with all process control and best practice
  • Healthcare Service Provider registration, induction and relationship management
  • Service tariff configuration and maintenance 
  • Reporting to all stakeholders

Membership Management

  • Membership data management(new member registration, member updates, terminations)
  • General communication , information distribution and correspondence handling
  • Call Centre and Switchboard services
  • Query Handling(member, service and other stakeholders - walk-ins
  • Member education and relationship management 
  • Reporting to all stakeholders

Financial Management

  • Contribution Management
  • Claims payment
  • Assist clients in consideration of investments options
  • Manage payments for clients 
  • Financial performance monitoring and reporting
  • Regulatory and international Financial Standards compliance

Information and Communication Technology

  • Backbone architecture to support the business and clients with superior cost-effective technology solutions to enhance processes and services
  • ICT environment controls and management
  • Business Continuity Plan Management

General Management Services

  • Medical aid advisory services
  • Benefit review and design
  • Service tariff negotiations(local and foreign)
  • Contracting and contract management for clients

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