Replacing Legacy Systems With Future-Proof Technology For A Leading TPA

The Background

A leading medical third-party administrator (TPA) based in the MENA region, operating across five countries for over 50 years, were held back by some limitations due to their aging legacy system. It lacked scalability and agility, which hindered their operational efficiency, business performance, and regulatory compliance. In short, they were in dire need of a tech refresh.

What We Did

We designed and implemented a comprehensive, future-proof technology architecture strategy, which involved developing a modern platform encompassing the core system, associated portals, and a mobile application.

Core System

The medical insurance core system covers every aspect of the medical insurance value chain:

• Underwriting and policy administration: Manages customer relationships, product pricing, agent handling, and policy renewals.

• Provider management: Handles managing profiles, financial details, contracts, and network management for providers.
• Approvals processing and claims adjudication: Automates and streamlines the approval and claims process through advanced engines.
• Receivables and payables: Provides detailed accounting for transactions related to claims and reimbursements, integrating seamlessly with financial systems.
• Regulatory compliance: Ensures compliance with regulatory requirements across multiple jurisdictions.
• Customer care: Delivers comprehensive customer support through health records management and integration with communication systems.

Portals

The three human-centric portals are tailored to enhance engagement and streamline processes:

• Provider portal: Efficient profile and contract management, batch claim submissions, and comprehensive reporting features.

• Partner portal: Tools for managing portfolios, requests, billing, and performance metrics, used by brokers, agents, and employers.

• Member app: Access to policy details, claims submission and tracking, provider networks, and potential up-sell or cross-sell opportunities, monitoring and reporting.

IT operations

Backed by our industry-specific expertise, we act as our client’s trusted consultant, readily suggesting potential improvements and necessary changes. We also provide full support for their IT department, helping their DevOps team implement best practices.

The Results