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
