Health Insurance

Claims / Policy Automation / Leakage Control


JSure

Health Claims and PreAuthorisation Platform

Health Insurance Claims and PreAuthorisation management is a complex process. We have spent over hundred man years to perfect our solution for your needs.

JSure platform is a custom enterprise solution which works as a part of your core insurance system. 

Core Functions

  • Web based claims file entry

  • Approval Flows

  • Payments Management for Providers

  • Document Exchange with Health Providers

Integrations

  • Doctor, Speciality and Title  Catalog

  • Core Insurance Platforms

  • Pricing Integration with JMed 

  • Policy Rules Integration with JRules

  • Integration with UW Exemptions

  • Intgegration with Hospital Information Systems

  • Integration with Pharmacies Through JPharmacy


 

JSure

Fraud / Abuse Management / Analytics & Reporting


JBig Anomaly Detection

The first stage of fraud and abuse management is Anomaly Detection, because there are no ready data sets to leverage Machine Learning algorithms.

JBig Anomaly targets not only fraudulent activities but also ways to explore areas to help you with immediate financial gain, get more insight into product performance, increase your bargaining power with providers. Manage your claims teams and pre authorisation rules better by increasing automation levels even higher.

JBig Anomaly Detection

Underwriting Management and Policy Production


JDocs for Underwriting and Policy Production

Onboarding process for health insurance which requires paper forms, doctor reviews and data entry is simplified through JDocs for Underwriting and Policy Production.

Your applicants can easily fill Smart Health Declaration forms via their mobile phone for all family members. The smart forms optimize questions to be asked based on the answers and identified risk groups delivering most value for your time.

Paper forms can also be imported via Smart Scan to be reviewed by underwriters.

Underwriting process for machine based risk review, doctors review, external medical record research and collection of sensitive data from other insurers are simplified. 

Monitoring your service levels for onboarding process will make critical improvement points easily recognized  and improved to deliver the best customer experience.

JDocs for Underwriting and Policy Production

Better Customer Service


JSure Mobile PreAuthorisation

JSure Mobile PreAuthorisation