Our Valued Customers, The ESKADENIA team would like to inform you that we are back in full force at the office and have continued normal operations while still following the Jordanian government’s COVID-19 safety procedures. Our activities may be subject to change during these uncertain times, but we assure you that any changes to our operations will not affect our level of service to our customers. We thank you for your cooperation and wish you good health. ESKADENIA Software Team
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Insurance is undergoing some major changes. Thanks to globalization, deregulations and many other factors, insurance is headed towards a transformative state. This is especially true when it comes to health. With some of the highest growth rate globally in the last years, health is becoming one of the main sectors within the insurance industry. With uncertainty and risks occurring every day, medical insurance is an important aspect to retain and develop, this is why many insurance companies today are shifting towards innovative means enabled by insurtech to receive the most accurate premium and policy results. Looking into more definite and personalized policies, how can the health insurance sector sustain the demands of the insured today? Thus, the rise of technology. Utilizing information systems, wearables, social media and more are shifting health insurance companies into more than your traditional means of insurers. ESKA® Medical is our health insurance management system, as part of our insurance management suite ESKA® Insures. This comprehensive system functions to streamline your medical insurance processes from start to end. It enables the digital transformation of medical insurance companies. With features such as production activities, medical networks management, claims processing and more, ESKA Medical covers all your medical insurance requirements. Catering to all parties involved within the health insurance sector, this inclusive system supports individuals, SMEs and corporations. Transform your policy administration and claims processing into an easy and direct flow.
Multiple access options Finding contracts, policies and other essential documents can be a hassle. This is especially true when you are dealing with multiple parties. ESKA Medical provides a mobile and portal access for the convenience of different parties, from providers to the policyholders. Flexible Medical Networks Now you can manage all your medical providers through one automated platform. From doctors and hospitals to pharmacies and laboratories. Organize and structure your networks of providers and their services through a dynamic digital database. Expand your sales network ESKA Medical makes issuing quotes and policies faster with the Quotation Builder, augmented by agent access portals. Together with customizable incentive strategies and sales analysis, ESKA Medical helps you engage customers with purpose and insight. Bancassurance Bancassurance opens the door to a new frontier of possibilities by bringing your insurance products to bank-affiliated customers. ESKA Medical empowers you to expand your market reach by building mutually fruitful relationships with banking institutions and the clients they serve. Bancassurance automates and accelerates the process of creating quotations, issuing policies, alterations and renewals. Customers can additionally file claims information and receive updates on their claim statuses right from their local bank. Providers pricelist and agreements Manage all your procedure and medicine prices with a convenient price list form. Now you can set your pricelist benchmark, as well as have all agreements and prices, including any discounts, directly imported according to your rules and preferences.
Underwriting taken care of Handling all underwriting services in no time. ESKA Medical is an all-in-one system ready to impress. By digitizing tasks like assessments and ratings, you can easily get your underwriting tasks done. Production made easy Generate quotes, set up plans, register policies, import member list and more with this fully comprehensive system. Automating various production tasks according to your standards, production can now be effortless and direct. Monitoring and control ESKA Medical enables you to monitor and control the daily transactions and operations of your insurance processes based on your pre-configured authority matrix, guidelines and procedures. This allows you to enforce your specific business flow and can be applied to all system processes in all areas. Claims processing under control Turning your claims management into an easy activity by automating the whole claim management process, from submission to adjudication and settlement. ESKA Medical provides convenience for all your claims handling. Made according to the rules ESKA Medical follows all standards and regulations from both the medical and insurance industry. Following ICD-9, ICD-10, ICD10AM, ICD10CM and CPT codes, as well as other rules made for your claims processing and third-party integrations. Seamlessly handle reinsurance Mitigate risks by creating a safe and conducive relationship between your insurance company and your reinsurance or co-insurance company. Helping to create secure and accurate treaties directly and digitally for full convenience. Configurable KPIs Configure various system KPIs to monitor your team’s performance, whether it’s related to production, claims handling, or any other system-related activities. Create a conducive platform to monitor your goals.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Medical Queries Sustaining a successful insurance business requires understanding your policies details: status across time, type, and class. ESKA® Medical provides powerful reporting and inquiry tools, so you can maximize your information’s accessibility and usefulness. The Medical Query is a powerful inquiry tool that lets you monitor any level of your operation’s performance, from the big picture down to specific insurance classes and individual policies. All data can be visualized using graphs and charts.
Production Queries
Provider Queries
Claim Queries
Statistical Queries The statistical Queries feature allows the management to monitor the business of their company
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:
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.
Digitizing your medical insurance operation ESKA Medical is a standalone Medical Insurance Management system that is also part of ESKA® Insures®, ESKADENIA’s end-to-end Insurance Management Software Suite that also contains the following core insurance systems:
ESKADENIA ensures that your potential grows within a unified operation. ESKADENIA provides an array of complementary software systems, so you can extend the core capabilities of ESKA General throughout the rest of your company’s operations and customer relationships.
Embrace comprehensive digital insurance operations!