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.
Web based claims file entry
Payments Management for Providers
Document Exchange with Health Providers
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
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.
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.