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Medical Claim Administration

GEMS constantly strives to improve customer satisfaction by using technology to boost their business processes. Health insurance Clients will benefit greatly from our ‘Online e-approval Systems' which enable our Help Desk team to analyze and respond to cases needing preauthorization with improved turnaround times. Our systems are enhanced to deliver faxes as scanned documents for instant access to our team. The system has also been integrated with an SMS facility that informs clients as well as Medical Providers of an approval or a rejection as it happens. Efforts towards ‘Paperless solutions' are enabling us to eliminate bulk transfer of documents and cut our manpower requirements. Our e-workflow process allows for the seamless transfer of the claims batch to various authority levels for digital approvals. Efforts are underway to apply the use of E-claims thereby reducing data entry errors and cutting down claims settlement turnaround time.

Claims cost control by using web based proprietary software and predefined protocols for medical bills review

Fraud Unit to control fraud/abuse

High quality medical auditing through a team of qualified doctors and data mining to control claims losses

Performance reports that track claims activity and key performance measures

Perform regular analyses to identify clients' high-cost, high-risk areas and recommend plans to improve outcomes

Data protection: member details are in trusted hands

Managing health portfolio for self funded groups