Health Insurance Management

 

Product Description

JBM’s Health Insurance management solution is designed for THIRD PARTY ADMINISTRATORs (TPAs) for medical claims administration. The solution is ideal for TPA and also INSURANCE COMPANY who manages the claim processing internally.

The solution is well integrated with JBM’s financials, thurs ensuring end to end business automation of the TPA organization.

Health insurance and TPA management solution provides following controls to the business:

  • Support both HMO and TPA plans as per the DHA, HAAD and northern emirates regulations.
  • Effective claim management.
  • Verification and Approval of claim pre-authorization request and also claims is completely system driven.
  • Prevent frauds and malpractice by the service providers.
  • Offer variety of covers to the end beneficiary and link the claims processing to the health insurance contracts.
  • Manage loss ratios effectively.
  • Address the reporting requirements of the insurance and reinsurance companies.
  • Seamless integration with JBM’s core financial accounting module.
  • Web Portal Add-on to get the customers and services providers to interact electronically.
  • Configurable multi-level workflow for the claims processing.
  • Abundant Statistical MIS to manage and address future underwriting requirements.
  • Complaint with the industry standards for E-CLAIMS processing (complete integration with DHA for prior request/authorization, eclaim and PBM functions).
  • Optional add on for E-CLAIM management is available with the application.
  • Invoicing and additional endorsements are just a click of button, where all the calculations are done by the system to avoid manual errors.