ESKA® Medical Insurance

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Overview

ESKA® Medical is a health insurance management system, as part of ESKADENIA's insurance management suite, ESKA® Insures.

This comprehensive system functions to speed up and simplify your medical insurance process from start to end. With features such as data recording, handling of production, medical networks, claims, renewals and more, ESKA Medical covers all your essential medical claims process.

Catering to all parties involved within the health insurance sector, this handy system supports companies, insurance company employees and insurance holders. Transform your claims processing into an easy and direct flow.

ESKA Medical covers a number of functionalities related, but not limited to:

  • Medical insurance production
  • Medical networks
  • Underwriting
  • Claims processing
  • Reinsurance agreements
  • Queries search
  • Portals access
  • Reporting and analysis

Key Features

  • Customize your insurance preferences, from medical services and underwriting tasks to claims and finances.
  • Web access for members, providers & policyholders.
  • Support ICD-9, ICD-10, & CPT codes.
  • Multiple medical networks with related price lists.
  • Automatically store claims’ information for reimbursement.
  • Claim auditing engine with over 120 defined rules.
  • Compliance with various governmental regulations.
  • Third-Party Administrators (TPA), Capitation business (HMO).
  • Manage all your medical providers through a digitalized medical database.
  • Conduct underwriting tasks through an automated and predefined process.
  • Handle reinsurance through a direct and digital process.
  • Provide a comprehensive report with a user-friendly dashboard/template.

Key Benefits

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.