Flexible Configuration

ESKA^® Medical provides full customization with its setup functionality. Allowing you to pick and define all your medical insurance preferences for medical services, production, handling claims, financial integration and more.

Presenting a fully personalized system, ESKA Medical will give you the option to set a range of parameters that suits your policies and insurance services. For example, define the ICDs you would like to include and the medical services covered (such as labs, X-rays, CPTs, etc.). You may also import your services through bulk action with the Import Medical Services function.

In addition, you may also setup your preferred criteria and rules that will be used later for your underwriting, pricing and production stages.

Create a comfortable workflow by setting up your preferences or claims processing. Let this flexible system also pre-define your financial needs, whether you are a stand-alone company or work with third party administrators (TPA).

Thanks to a fully dynamic system, you can set and plan everything you need beforehand, easing any process you have to face with your medical insurance flow.

• Select and define ICDs, such as non-standard coding systems, ICD-9, ICD-10, ICD-10am, ICD10- cm and all the latest codes from WHO.
• Define a list of medical services types.
• Assign underwriting and production parameters to create new medical plans with its classes.
• Provide the necessary setting to control claims processing.
• Set your financial setups, such as payment cycles, closing periods, TPAs and more.
• Define codes and parameters to be used throughout the system.
• Assign roles and tasks for users or employees.

Medical Networks

ESKA^® Medical’s medical networks function looks to define and manage all your network providers. With a range of providers to choose from, such as doctors, hospitals, pharmacies, radiology centres and more, you can directly and easily organize your list of networks.

Storing detailed information about each one of your providers, you can easily view any essential data needed about your network. This may include their personal or medical information, including specialty, location, follow up period, processing period, grace period and tax information.

You may also view what network each provider is linked to and assign any new networks if needed. This includes easily copying any network and viewing the network classes.

In addition, you can enter any additional information you need about your providers, such as any alternative names, attaching any related documents or adding any notes that should appear within the Claims section of the system.

From here you can define medical provider agreements, including service price list and discounts. This feature allows you to create a standard service pricelist that you can use as a baseline and for benchmarking purposes.

Systematically store your medical network’s information through a powerful system; from choosing your providers, services and start and end periods to adding or removing providers. We have the answer for convenience.

• Store a list of your network providers and their information, including their personal information, medical services and contact details.
• Provide a price list of your network classes.
• Present the related networks connected to your providers, as well as edit and modify your networks.
• Keep track of transactions conducted to your providers.
• Set any related benefits, services and historical discounts for each provider.

Takaful

In addition to its conventional configurations, ESKA® Medical enables you to build Takaful-based insurance schemes.

Takaful in ESKA Medical provides you the ability to design insurance schemes according to the Wakalah business models. It provides a robust solution for retaining and distributing profits for each business line per insurance product.

To help you design a Takaful-based system, ESKA Medical supports various Takaful fee setups and calculation factors. You can also control surpluses, capital reserves, and incentive and fundmanagement fees. ESKA Medical enables you to define participant and shareholder roles for your customers as well as Takaful-based operator and risk funds.

Wielding Takaful-based methods for collectivizing risk, managing investments and distributing payouts ultimately yields you a more diverse product portfolio, which can attract a wider breadth of prospective customers in the market.

• Intelligently calculate Wakalah fees for specific policies under different policy types using a userfriendly setup.
• Set attributes for each premium, including whether a premium is editable, discountable, formula calculable, basic, active, or linked to sum-insured.
• Maintain auditing and transactions histories for your insurance policies.
• Attach and track necessary fees and taxes to any policy type in your portfolio.
• Manage premiums and claims under consolidated accounts with ESKA Financial.
• Apply discounts or tariffs for any policy, policy type or customer.

Comprehensive Sales Network

In tandem with a stronger operations infrastructure, a streamlined sales force and marketing strategy can help you retain pre-existing customers and bring in new ones. ESKA Medical features comprehensive sales network management that enables you to clearly understand and adjust your sales channels for optimal effectiveness.

To facilitate effective supervision, ESKA Medical maintains a complete overview of your sales force and its details, from your business channels to the sales professionals that operate within them. To complement your in-house sales force, your sales management can extend to encompass your indirect sales venues, including brokers, external agents, and bancassurance channels. Any sales professional and their tasks can be adjusted or transferred as you need.

Regardless of their channel, all sales professionals can access the quotation builder through the agent portal, so they can quickly issue tailored insurance quotes and policies to their customers. The system also lets you comprehensively define how you offer commissions and bonuses to sales professionals while tracking their activities and expenses in-sync with ESKA Financial and HR.

By administering your sales force with clarity and purpose, ESKA Medical enables you to realize a better-articulated sales strategy.

• Dynamically define your sales network to the n-level, from agencies to individuals.
• Seamlessly incorporate agents, brokers and bancassurance reps into your sales network.
• Configure commissions and bonus rates according to parameters you choose.
• Let your agents track their progress towards defined company objectives.
• Measure agent achievements against sales targets with consideration for:
  • Branch
  • Business and product types
  • Position
  • Term
  • Target type and amount (intended contributions or number of policies)
• Extend your sales reach to bank-affiliated customers with bancassurance.
• Connect your sales professionals with key tasks using the agent portal.
• Integrate with ESKA CRM to augment your sales processes with the advantages of digital marketing.

Underwriting & Pricing

ESKA^® Medical has all your underwriting activities covered with fully extensive features to accelerate your quotation process. This may include defining any possible rates and parameters for your pricing needs.

Through the pricing functionality, your underwriters can set the right parameters that will affect your pricing, as well as define your premiums with their expected probabilities. Creating a fully customizable system, you can easily apply the values of your parameters that will correlate with your customer’s needs.

In addition, ESKA Medical also automates your whole pricing process once your underwriters digitally review and analyse the risks your insurers possess based on claims experience. This will help you to determine any decisions needed in the pricing and production stages.

Once the pricing stage is completed, you may move to the production stage, where the system will retrieve the related premiums based on the parameters set. All processes conducted will be automatically updated in the production stage based on the decisions made from you underwriting process.

Thanks to a fully automated pricing system, you can move faster and more thoroughly with your underwriting/production stage.

Create a fully automated pricing process with ESKA Medical, streamlining your assessment needs. Thanks to an easily customizable system, you can experience a more convenient operation for pricing quotation. operation for pricing quotation.

• Provide a user-friendly display about your insurers’ information.
• Dynamically define parameters that affect the pricing.
• Generate the matrix based on the combination of parameters’ values.
• Define premiums with all expected probabilities.
• Select the parameters’ values that match customers’ needs.

Production Services

ESKA^® Medical provides a powerful system that is made to handle the production phase of your medical insurance’s operation. From building plans and generating quotations to issuing policies, adding endorsement and renewing policies, consider yourself covered.

Thanks to a comprehensive system, you can digitally create your policies’ medical plans and classes based on your specific needs. This also includes defining their benefits, premiums, exclusions, waiting periods and more.

You may also convert your quotations directly into policies, once approved, and copy or create a new version of your quotations. With the ability to automatically create sales quotations, you can serve a fully customized audience with less time and hassle.

Why not also make documenting members into a simple process with the ability to bulk import your members and their details through ESKA Medical’s Excel^® format.

ESKA Medical’s integration with ESKA Financial, our financial management system, also creates a smooth process for handling all data in your medical insurance processing. This convenient system automatically calculates your premiums based on the policies made where a financial voucher will then be generated through ESKA Financial.

Handle all your production or underwriting services through one digital platform, storing all information you need for your policies. Furthermore, you may easily create modifications to existing policies by creating endorsements, whether for any extensions, cancellations, freezes and more.

• Build plans and classes with its details (benefits, premiums, exclusions, etc.)
• Generate quotes, which can later be converted to policies.
• Create policies based on your specific requirements.
• Insert member information, which can be placed one-by-one or inserted in bulk through the Bulk Import option.
• Create endorsements for any modifications to existing policies.
• Easily renew your policies before or after the expiry dates.
• Integrate with ESKA Financial for voucher generation and calculations of premiums.

Claims Processing

Claims processing is one of the most critical activities insurance companies execute, yet is an extremely high impact area of the insurance business. However, the complexity of managing claims can create errors and delays that can cause irreversible harm.

ESKA^® Medical’s claims processing helps organizations simplify the claims process; the system supports claims management and processing for a variety of claims types, whether they are within the network (direct billing) or reimbursement sent by policy holders or insured members, all can be processed in one place.

Your claims process is based on the providers’ batch covers. Claims are usually submitted in batches with a common serial number. This handy system allows for bulk claims upload through the import feature.

Experience a powerful claims management process that will help you reorganize all tasks. From defining your claims to auditing them, handle everything in no time. Furthermore, ESKA Medical also conducts the auditing process for all batches or selected claims. The auditing process is easily applied through a click of a button, where it will set a number of predefined rules to automatically reject or approve the claim’s status. This may include open, onhold, approved, rejected, missing information and more.

Thanks to a fully automated system, all settlements – whether complete, partial and adjustment settlements – can then be managed through ESKADENIA’s financial system. All claims may also be reversed for correction purposes.

• Create batch covers for your claims along with identification codes to ease any searching processes.
• Provide bulk claim uploads from an import feature.
• Conduct an auditing process for your claims.
• Automatically change the status of your claims accordingly.
• Reverse the settled batch or claims that were posted mistakenly to the wrong provider or policy holder.

Reinsurance Management

Reinsurance programs can be extremely complex, with multiple covers and layers, and varying terms and conditions. ESKA^® Medical’s system provides solutions for managing reinsurance easily.

This comprehensive system helps you to handle all reinsurance treaties, including any treaty renewals. Supporting various treaty types, ESKA Medical can help to manage all your reinsurance needs.

ESKA Medical will also automatically protect your posted policies under the default treaty, whether it is a quota share treaty or retention treaty. Once a claim is settled, the approved amount will be automatically distributed based on the policy treaty.

The reinsurance functionality can also help support your bordereau processing, which will be generated every quarter. Once the bordereau is produced, ESKA Medical will provide a credit note. If the bordereau hits the amount stated or exceeds it, you may still generate a credit note through the system’s Loss Advice form.

Now you can make your whole insurance process easily traceable and reviewed.

Receive a comprehensive view about your reinsurance with the right tools and features. Now you can easily generate all insurance needs in no time thanks to a fully automated system.

• Manage your reinsurance treaties.
• Thoroughly document your policies details within your insurance treaties.
• Automatically distribute your premiums.
• Automatic reconciliation upon the bordereau process for all premium and claims distribution.
• Digitally generate any relevant vouchers thanks to our integration with ESKA Financial.

Smart Access

ESKA^® Medical’s online portals are interactive, insurance-specific solutions that help insurance companies enhance service levels, cut costs and increase sales capabilities. ESKA Medical supports customer and sale portals, as well as a mobile app, enabling your customers to fully appreciate the daily benefits of medical insurance. Support your customers and insurance providers through the right channels

Providers Access
Connecting with providers has never been this easy; ESKA Medical gives access to providers so they can submit and review their batches and claims.

• Submit/review batches and claims
• Request for preauthorization

Customer Access
Members Access
This portal gives members access to their data; they can view last status in the active policy. Once the member login, he/she can view their information and transactions in their previous policies. Also, members can submit their claims and attach scanned copies to be processed by the insurance company, request for preauthorization from the insurance company, or view the previously defined preauthorization.

• View your data with a single click
• View your dependents data
• Submit claims
• Request for preauthorisation

Policyholders Access
Through this portal, the policyholders can inquire about any transaction that occur on their policies, as any transaction that takes place on the policy in the Insurance Company will be immediately reflected on the system and can be viewed by the policyholder at any time.

• View the policy status and details
• Trace endorsements lists
• Add new endorsements and enrol members
• Review and submit reimbursement claims
• Request for preauthorization

Customer App
The native mobile app brings an accelerated ESKA Medical Customer Portal to your clients’ smartphones and tablets, enabling them to explore and review their policies’ details and premium statuses on the go.

• Communicate policy details and benefits to your customers with the customer portal.
• Accelerate the customer portal’s mobile experience through the ESKA Medical mobile app.

Sales Tools and Access
ESKA General supports your sales professionals directly with a toolkit of functions and features to help them better connect with customers.

Agent Portal: To optimize the way external sales professionals interact with your insurance operation, ESKA General features an Agent Portal that enables them to issue quotes, policies and alterations using straight-through processing (STP).

Reports and Dashboards

ESKA^® Medical generates a number of reports to help with your tracking and summary needs. From production and claims to medical network and reinsurance reports, in addition to displaying all your essential data through a read-friendly dashboard.

With over 100 standard reports to choose from, you can easily find the right option to help with your analysis. Consisting of through details about your reinsurance bordereau, member information, referrals, network providers and more.

In addition, all main information regarding your health insurance details, whether a claim, policy, etc., will be showcased through a user-friendly dashboard. Through the use of data visualizations, dashboards simplify complex data sets to provide users with, at a glance, awareness of current performance.

ESKA Medical Dashboard presents numerical data in different types of charts such as bar charts, pie charts and doughnut charts where charts can be viewed as 3D charts, right angle axis and clustered charts. The dashboards can be divided into the following:

• Production Dashboards such as (Monthly Production, Monthly Production per business type, active policies per month, or active members per month)
• Claims Dashboards such as (Claims per Benefits, Approval per Benefit, Max Claim Amount, and Max Number of claims by policy).

Have all information and data about your medical insurance summed up through reports and dashboards for a more thorough look. Enjoy the convenience of keeping track of your financial transactions as well by viewing any transactions preformed on your provider.

• Produce various report templates for different insurance stages.
• Generate information via visual dashboards.
• Create a thorough summary of your medical insurance progress
• Choose reports and dashboards accordingly to your personalized needs.