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Health Funds

Over the past few years, the health insurance industry has faced a number of significant transformations:

  • the growing volume of information
  • new business models
  • increasing competition
  • market volatility
  • customer experience and expectations
Some of the most common challenges are below.
Partial Insights - Silos of Information
Valuable information can be found in the main platform (HAMBS or other) as well as E5, other ERPs, CRMs, and web-based sources. ​This creates an additional hurdle when it comes to consolidating data and producing a 360 degree view.​

Many Health Funds struggle with:

The inability to get a comprehensive view or the full story about their members’ journey, ​

Understanding churn trends,

Identifying policy and ancillary movements at a granular level, ​

Analysing the quality of previous interactions,

Profitability levels
Manual & cumbersome tasks persist
Various departments are still spending time on manual, error-prone spreadsheets to produce reports & dashboards. Revenue growth and cost control are limited by a lack of modern solutions & processes to produce granular, accurate and real-time analysis.
Low visibility on Fraud & Claims
With the growing number of members & data volume, it becomes harder to quickly identify anomalies using traditional spreadsheets or standard BI tools. ​Better Fraud Detection is possible thanks to comprehensive datasets (Members, bank, claims, financial…), granular analysis, and machine-assisted insights using Artificial Intelligence (AI) and Machine Learning (ML).​
A changing ecosystem
The last industry reform in April 2019 was aimed at simplifying and harmonising premiums across Australia, helping customers to easily compare offers from various providers. This is putting additional pressure on health funds to make sure their offer is competitive, profitable, and to be able to benchmark themselves against their competitors.
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Business Outcomes

​Solving these challenges has had a significant impact on our customers.

Optimise Revenue

Support Sales & Marketing teams with real-time insights to support market-driven decisions

(Policy & Ancillary reports, profitability analysis…)

Improve Productivity

Help teams spend less time on time-consuming manual tasks, and more time on value-added analysis

Self-Service reporting and less dependency upon IT

Improve Member Satisfaction & Retention

Monitor member satisfaction & improve customer experience by providing the sales & marketing teams with comprehensive, real-time, granular information.

Reduce Costs

Detect, investigate and reduce the cost of Fraud, Waste & Claim abuse

Identify low-profitability policies, ancillaries & members

Help the Finance team analyse costs in a granular, accurate and quick way

Reduce Risk

Mitigate the risk of fraud, budget overruns, non-profitable policies, fraudulent members…

Use a powerful & modern self-service platform used by 48,000+ organisations across the globe

Our Methodology

Agile approach

Project are split into sprints

Delivering quick results, adjusting requirement, building self-sufficiency

Ongoing Support

Guarantee long-term satisfaction​

Outcome focused

Step by step implementation

Think big, start with priority topics, deliver quick wins

End user engagement

Hands-on training and user empowerment

Policy, Ancillary, Member Reports

  • Policy and Ancillary repartition & movements: Upgrades, downgrades, product moves: Acquired/Terminated/Suspended/Active
  • Members demographics and Geo-mapping
  • Forecasting & Predictive growth & movement modelling

Competitive Intelligence

– Competitive intelligence & product benchmarking using PHIS data to understand the market ecosystem and ensure competitiveness
– Industry Comparisons: Variance to Industry, Age Band Distribution analysis, Demographics…

 

Operations

  • Customer Journey Analysis
  • KPI Dashboard with Trends (Calls & Quality KPIs)
  • Productivity, Error Rates, Call QA, Member Experience…
  • Web Analytics (Google, Social Media…)

Claims and Fraud

Fraud schemes are:
  • Increasingly sophisticated
  • More and more agile
  • Higher velocity
A good solution must:
  • Integrate comprehensive datasets
  • Match identities across all sources
  • Consider data quality
  • Be agile & adaptable

Some of our customers using our Insurance Analytics solutions…

Schedule your personalised demo today!

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