Our administration services

  Customer contact centre

We realise that simply knowing what to do can help save a life! Our call centre staff are medically trained to provide basic care and address your medical questions over the phone. By investing in the latest call centre technology and training our staff to use it, we operate with practically zero-down time. So when we say our call centre is open 24 hours a day, seven days a week, we really mean it.

Call our customer contact centre now on 01 – 448 2105 or 01 – 460 7560
or toll free on 0800 – CALL THT (0800 2255 848).
 

  Claims management

We take the processing and timely payment of claims very seriously, which is the reason we have invested hugely in this unit of our organization. It starts with receipt of claims and ends with disbursement of payment, involving a complex process of data management, vetting, capturing and quality assurance. This is only possible through the use of our proprietary software called MEDWARE, a robust and adaptable administration system. For efficiency and better results, our claims management team comprises highly trained medical professionals, with both clinical and administration experience.

  Provider management

We have a team of provider managers, whose responsibility is to ensure that excellent relationships are maintained with all of our providers (hospitals, clinics, diagnostic centres etc.). They verify that our providers understand our plans, and that they treat our members with empathy, respect and dignity, while exercising best practice clinical care. The following are functions of the provider management unit:
  Training and re-training of providers
  Accreditation and re-accreditation of providers
  Providers reconciliation
  Peer review
  Resolutions of dispute and queries
  Tariff negotiation

  Case management

Our specialist case management team personalises the care that our members receive at our accredited health care providers. Our intention is to ensure that our members are receiving the right care, with the right medical personnel and that such care is authorized promptly. The unit is comprised of senior medical practitioners, including medical doctors with several years of clinical experience. Their functions include:
  Medical advice
  Referral management
  Peer review
  Members benefit management
  Arrangement for special services
  Authorization management
  Recommendation of coverage exceptions where appropriate

  Client relationship management

Our business is focussed around our customers. We do not just insure health care; we build a relationship with our customers. Every client is allocated a key account officer, whose role is to ensure that the customer is well enlightened about the product. The key account officer will ensure that escalations are promptly dealt with, renewals are handled seamlessly, periodic employee group visits are carried out and that periodic reports are sent to client. The key account officer will arrange on-site client support and organize wellness days for employer groups.