We had a chat with Dr Omolola Odedere, Head, FWA, AXA Mansard Health Nigeria. The text has been edited for easy reading.
At AXA Mansard Health, Nigeria, we arguably work with the most Healthcare Providers (Hospitals, Pharmacies, Labs, etc) in the country due to the vantage position we occupy in the industry. With each of these Providers, there is a price list or tariff, which is a list of pricing for all care items the providers provide to our insured members.
Working with that number of Providers introduces a unique challenge with managing the tariffs which are usually unstructured. These unstructured data from the tariff makes it difficult to automate most of the processes with these providers, including Claims Management, Pre-authorization management, provider enrollment, etc
So before Curacel, we struggled with finding a solution to structuring the data we get in form of pricing from the providers.
Yes yes! Like I just mentioned, our priority was to automate most of our processes and it was practically a herculean task without the data standardisation that Curacel helped achieve.
That was step 1. Step 2 is then to complete the whole automation. I am sure you understand how Health Insurance works, where we are only a great business if our insured members get access to the best care from our Providers. And our Providers will only give our members the best care if we have a good relationship with them, and reimburse them on time. All of these require automation, to speed up things and do more.
Errmmm…Should I? (laughs)
Step 2 is not just one thing, but the goal there is to finalise the things we are putting together to fully automate the processes.
For example, with Curacel, we have Curacel Detection. This enables us to do a number of things, including automatically detecting fraud from submitted claims, automating claims processing, and most importantly, achieving an industry-record turnaround time in Claims processing.
You can say that, yes. It has been an issue. Sometimes, it is a deliberate attempt by the Providers to game the system. Sometimes, it is an error. What all of these point to is the fact that we need to tighten some loose screws, have better data and better technology.
Traditionally, you would rely on humans to fish out the fraudulent and erroneous claims. At our scale, this is way harder. This is where technology comes in, that’s where Curacel Detection comes in.
Ha, no o! You want me to give tips to other insurers? (laughs)
Okay, more seriously though, any serious business in this industry should take adopting trending technologies very seriously. And that is where companies like Curacel come in. It is their expertise, and in my opinion, they do way better than in-house technology teams, or technologies from abroad.
Rapid technology adoption is the way forward to achieving all the business goals that we have.
Like I said, our goal is (to be) the best service delivery to our customers, our Providers and even our stakeholders. We know exactly what we need to do to get this done, and are already on our way.
Dr Omolola Odedere, Head, FWA, AXA Mansard Health Nigeria
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