Revolutionising the processing of medical aid claims to drive customer loyalty and engender trust

A leading South African medical aid insurer trusted BSG to implement a large-scale, high-risk and complex system replacement; allowing for innovation and flexibility while ensuring existing, daily business operations weren’t impacted.

overview of the clients needs
  • Ability to pay as per authorisation for a medical treatment
  • Build trust with customers to drive loyalty
  • Replace the 20-year old legacy system
  • Adopt and administer new medical aid schemes through a configurable set of administrative rules to ensure transparency and manage risk
  • Limit IT dependency by enabling business to update and configure the new system without involving system teams
  • Enable strategic growth through new architecture for the business domain

Develop a highly configurable claims processing and benefit authorisation and management system to support the insurer’s long-term strategic vision:

  • Define a simplified and scalable new system design
  • Ensure a flexible and configurable platform for quick changes with full predictability of the impact and outcome
  • Support end-to-end process integration, maximum automation, precision execution and operational excellence
  • Ensure full traceability of all transactions and outcomes, simulation ability and multi-dimensional view of data to enable advanced risk management and better product design
  • Better managed and more seamless application process for authorisations and claims
  • Enhanced customer experience through smoother operating processes and quicker access to additional innovative products
  • Faster release of new products and enhancements to meet customer requirements through reduced implementation cycles
  • Improved user interface (UI), integration points and interfaces with external systems, with optimised internal databases

Integrating claims and authorisations to allow the flexibility needed for quicker reaction to market changes and customer requirements and demands.

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