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Medical Aid Fund Administration

Fund Administration

Comprehensive tracking of fund performance with regular, detailed reports for stakeholders to ensure full transparency and effective resource management.
Fund performance and reporting
Maintaining accounting, books and records of the schemes
Management of solvency margins

Claims Management

Fast, automated claim processing across various channels, adhering strictly to scheme rules and best practices, ensuring timely and accurate payments.
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
Service tariff configuration and maintenance
Reporting to all stakeholders

Membership Management

End-to-end member service including new registrations, updates, and terminations. Our dedicated team ensures effective communication and member support.
Membership data management(new member registration, member updates, terminations)
General communication , information distribution and correspondence handling
Management of solvency margins
Member education and relationship management
Reporting to all stakeholders

Financial Management

Overseeing contribution collection, claims payments, investment guidance, and regulatory compliance, while providing insightful financial performance reports.
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

Robust, secure technology solutions supporting our services, ensuring seamless operations, data protection, and a comprehensive business continuity plan.
ICT environment controls and management
Backbone architecture to support the business and clients with superior cost-effective technology solutions to enhance processes and services
Business Continuity Plan Management

General Management Services

We offer customized advisory services on medical aid, benefit design, and tariff negotiations, tailored to meet each client’s unique needs and goals.
Medical aid advisory services
Benefit review and design
Service tariff negotiations(local and foreign)
Contracting and contract management for clients