• A New Ecosystem

    "We're creating a new ecosystem with automated, electronic solutions for group health insurers and self insurers that eliminates manual processes, paperwork, human error and inconsistencies and speeds up payment and settlement."

  • Narrowing the Gap

    "A good insurer is constantly straining to narrow the gap between premiums and costs. They want to lower administration costs, pay out less in claims by improving their accuracy and handling, manage external costs and incentivise brokers to continue to sell their products year in year out."

  • Online Collaboration

    "The OMNIQ system allows online collaboration between key stakeholders – insurer, broker, employer, member, health providers."

  • Reduce Risk and Cost

    "While many insurance companies realise they need to implement new business processes, they also discover that their systems have become overly complicated and cumbersome, increasing both risks and delivery costs."

  • Transparency

    "The insurance world is changing. The old model is broken. The silos are going. The cloud creates a transparent, seamless collaboration from end to end and exposes the traps where money and inefficiencies are locked."

OMNIQ Solutions to Common Problems

Loss Ratio Management

Problem

  • Claims complex, hard to comprehend, 7 days to turn around
  • Provider information hard to reconcile
  • Benefit limits often not understood
  • Payment to providers force premium rate cards – sometimes 40% over

Solution

  • Automatic claims adjudication
  • ICD10 coding
  • Underwriting limits stored on the same system
  • Adjudication system allows real-time payments
  • DRG and UCC sets contract rates and trend analysis

Administration Management

Problem

  • Large, centrally administered back office functions
  • 1: 1,000 ratio of administration staff  to insured members insured
  • Policy, financial and claims systems often not integrated
  • Policy information and interpretation complex and manual

Solution

  • Transactions pushed to point-of-service
  • 1 : 10,000 ratio of administration staff  to insured members insured
  • Single claims, underwriting, policy and financial framework
  • Policy interpretation rules based and immediate

Flexible product set-up

Problem

  • Legacy health insurance systems often take months to establish new insurance products and benefits
  • Insufficient flexibility to enable quick response to market or specific company needs
  • Challenges to make profits controlled by systems that can not adapt with the times.

Solution

  • OMNIQ’s product and benefit configurator allows all underwriting limits and rules to be set up in minutes
  • Complex insurance products can be released to the market in hours, not days or even months as is often the case

Automatic Rules Based Adjudication

Problem

  • Time consuming
  • Slow
  • Error prone
  • Inefficient
  • Multiple handling

Solution

  • OMNIQ automatic rules based adjudication completes over one hundred adjudication checks  in sub second not days to process claims
  • Removes all operator interventions in determining the applicability of a claim to the benefits provided under the policy
  • Creates an objective environment
  • Reduces significantly the volume of claims that can be processed
  • Improves the loss ratio by trapping any over payments and over servicing

Real Time Data Analysis

Problem

  • Slow delivery of data analysis
  • Risk management potentially compromised

Solution

  • Information available to view in real time and can be seen in graphical form
  • Support effective risk management

OMNIQ Group Health
Administration System

  • Share the information and the workload
  • Self service on line
  • Integrated cloud-based package solution
  • Flexible, scalable and fully configurable
  • Automated rule-based claims adjudication
  • IBM validated and accredited health insurance provider
  • Expert implementation advice on hand

Contact OMNIQ Care Consultant

Contact Us
+64-9-915-3518
enquiries@omniq.co.nz
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