TPA Service – Service Scope
Insmart provides comprehensive claim management services for health insurance products from the beginning to the end in product development, together with after-sales service and customer care.
1. Product design
With over 10 years of experience in implementing TPA services related to health insurance and medical treatment in Vietnamese market, Insmart provides detailed advices to help insurers have a more realistic and comprehensive outlook about the domestic health insurance market, serving for product design.
Our practical implementation experience will also help insurers improve and increase the value of insurance programs, thereby, managing and developing products more easily and effectively.
2. Contract and insured list management
Our system is designed to be flexible and can be adjusted according to details of insurance policies. Also, it provides specialized warnings for different customers.
3. Claim file management
Insmart maintains many options for receiving documents to ensure maximum convenience and support for insured. Original files are strictly managed before returning to the insurers; while soft copies are stored with a tight structure and absolute security system.
4. Compensation management
Evaluating claim files is an important step in ensuring that the right benefits are paid to insured. In addition to a claim settlement specialist team, Insmart also owns a group of doctors with professional qualifications and extensive experience in evaluating medical documents and health insurance claims, ensuring the analyzing process, separate costs according to the insurance benefits of insured.
Besides, Insmart’s direct billing service with a wide coverage, being linked and closed coordination with medical providers, helps increase convenience for insured while examination and speed up the process of benefit payment for them.
5. Insurance benefit payment and Compensation fund management
A team of experienced and dedicated claim settlement specialists, combined with our professional system, makes the claim settlement more objective, flexible, and transparent. It guarantees the transparency of insurance programs, meanwhile, still providing maximum support to insured.
The compensation fund is closely monitored and timely updated to insurers in order to ensure the progress of benefit payment.
6. Reports
Insmart’s system provides a variety of reports based on claim data of each insurance program. Periodic analysis report templates are presented on a new and intuitive technology platform. Analytical information can serve as a basis for building insurance policies and programs that are tailored to the needs of the market.
7. Customer care
Our call center supports and advises on looking up claim file and compensation status.
