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Health insurance is attracting more and more attention in low and middle-income countries as a means for improving health care utilization and protecting households against impoverishment from out-of-pocket expenditures.

Health Insurance solutions from JMR’s Avenir Health Insurance module has been built with the following features to fulfill the present and future needs of insurers:

  • Configure end-to-end policy administration using screen builder and product configuration engine starting from Enrollment to Claims.
  • Customizable Third Party Administration using state-of-the-art workflow and rule engine.
  • Extensive provider admin and provider contract functionality.
  • Powerful claims processing that include pricing, adjudication and straight through processing.
  • Supports multiple levels of authorization.

Avenir also support business processes and enable health insurers to implement required changes and offer customized products to customers. All these solutions can be uniformly processed with the help of administrative tools. With JMR’s health insurance solutions, you can:

  • Automate claims processing and pricing as well as adjudicate claims quickly
  • Manage ad-hoc and periodic reimbursements that are not part of the system
  • Automate processes in the case of suppliers and providers
  • Implement a rule driver accumulator configuration model
  • Use detailed analytics methods and tools to support business decisions
  • Configure benefits plans platform to calculate liabilities

Benefits:

  • Lower TCO
  • Adaptive, high-performance, rules-driven, flexible SOA architecture
  • Enhanced productivity and high auto-adjudication rates
  • Meet emerging market and regulatory demands quickly
  • Increased provider satisfaction

If you need more information or if you are not able to find what you need

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