Agents, insurance adviser

Saudi NEXtCARE
Saudi NEXtCARE We are the leading Third Party Administrator in the MENA region, recognized by our customers as providers of quality services; we will continuously work on improving them, growing into new markets and upholding our core values and commitments, while continuously maintaining our high standards. What we do We maintain a continued focus on our customers and their changing needs, by listening and conducting ongoing reviews of our customer service approach. We periodically review our internal processes in order to maximize efficiency of claims authorization and processing. We keep our systems up-to-date as part of our integrated solutions to clients ensuring that we are leaders within this field. Customer Service :: NEXtCARE prides itself on continuous commitment to excellence through the ability to work with the customer with the aim of exceeding expectations, taking experiences, working on them for continuous improvement and ultimately gaining sustainable competitive advantage in the market. All interactions are an opportunity for building the customer relationships through careful listening, proactive solution handling and successes, in turn adding value and depth to the services we provide. more...
MedNet Saudi Arabia LLC
MedNet Saudi Arabia LLC MedNet Saudi Arabia LLC : Expert and reliable managed care services to the benefit of all stakeholders in healthcare – from patients to healthcare providers and health insurance companies – that’s what MedNet delivers. At the centre of our business model is the insured member: by cooperating with health insurers and selecting, monitoring and supporting clinics and medical doctors, MedNet ensures that patients receive excellent service and the best care possible. Based on in-depth knowledge of up-to-date tools and technologies and a clearly solution-oriented approach, we work to achieve better healthcare outcomes, cost containment and outstanding customer satisfaction. At the same time, our managed care services contribute to securing the future viability of healthcare schemes. With more than 20 years of experience in the market as well as the knowledge, resources, backing and stability of a globally leading reinsurer, MedNet is ideally positioned to support insurers in mastering tomorrow’s healthcare challenges. MedNet is a member of Munich Health, the healthcare brand of Munich Re. more...
GlobeMed Saudi
GlobeMed Saudi GlobeMed Saudi is the leading healthcare benefits management company in the country, offering support to insurance companies with highly advanced tools and services, such as providers’ network management, approvals and claims processing, settlement to providers and reconciliation, customer services and business intelligence services. Moreover, GlobeMed Saudi provides innovative and comprehensive services to manage its clients’ complex needs, such as international health services. Backed up by GlobeMed group’s 20 years experience and know-how, GlobeMed Saudi has all the human and technical skills required to offer its stakeholders state-of-the-art solutions and tailor-made services. It is part of a network of 12 franchised companies spread across the Middle-Eastern and African territories, in Lebanon, Ivory Coast, Syria, Kuwait, Qatar, UAE, Bahrain, Jordan, Palestine, Egypt and Nigeria. The region’s fastest growing group in the healthcare sector offers now international and cross border services to over 2 million lives, through a network that exceeds 500,000 providers worldwide. Over the past 8 years, GlobeMed Saudi has lived up to its promise of improving the healthcare services to more than 7 client insurers, and more than 1,400,000 insured members. Licensed from the Saudi Arabian Monetary Agency (SAMA) in 2008, and from the Council of Cooperative Health Insurance (CCHI) in 2009. GlobeMed Saudi is registered under CR: 1010197582 with a paid capital of 15,000,000 SR . more...
Gulf Electronic Management Systems W.L.L. (GEMS)
Gulf Electronic Management Systems  W.L.L. (GEMS) Gulf Electronic Management Systems W.L.L. (GEMS), the first TPA Company licensed in Bahrain, is a joint venture with: 60% holding by Gulf Union Insurance and Project Management Holdings Co BSC (closed) chaired by Mr. Abdul Aziz Jassim Kanoo, which is one of the top insurance conglomerates in the Arab world with over US $200 million consolidated gross premiums 15% holding by Gulf Union Insurance and Reinsurance Co. BSC (closed) chaired by Sheikh Ibrahim bin Hamad Al-Khalifa 25% holding by Focus Holdings (I) Pvt. Ltd. from India, a group whose business interests include TPA services GEMS is managed by its Chairman and Executive Director, Mr. Percy Albert Sequeira and is registered under the Ministry of Commerce and Industry, Kingdom of Bahrain with CR No. 59113 dated 27th December 2005. Over the past five years GEMS has successfully outsourced business from the Gulf Union Insurance Group and manages the back end of the Company's Medical Insurance portfolio handling over 240,000 lives in Bahrain and KSA. In addition, GEMS also operates the back end for Gulf Union's Motor Insurance and Workshop portfolio. Last year GEMS processed around 15,000 motor claims corresponding to 62,990 cars insured procuring BD 800,000 worth of parts in the process from a widespread network of spare parts suppliers in Bahrain and KSA. An increasingly competitive business environment drives companies to look at ways and means to reduce costs - GEMS offers a range of services that help companies achieve a competitive edge. GEMS SCOPE OF OPERATION Medical Claims Processing and Cost control for Insurance Companies and Self Funded Groups using web based proprietary software, qualified doctors and a team of proficient well trained processing executives Cashless Hospitalization Benefits at over 470 Networked Health Care Providers in Bahrain and KSA Regular feedback to clients on claims patterns and trends with suggestions and recommendations to improve outcomes Toll free helpline for customer convenience Motor Claims processing from registration to settlement - currently developing a web based software to take care of the the above Outsourcing the accounting functions of SMEs . more...
Council Of Cooperative Health Insurance
Council Of Cooperative Health Insurance Qualifying department qualifies insurance companies to participate in the cooperative health insurance business, and qualifies third party administrative companies to handle cooperative health insurance claims. Moreover, oversee the performance of companies and supervise them to do their responsibilities stated by the Cooperative Health Insurance Law and its Implementing regulation and its standardize policy. Tasks and responsibilities :: First, overseeing the implementation of the system: Control over the comprehensive health insurance coverage. Rehabilitation of insurance companies to transact insurance business health. The adoption of health service providers. Osaddad Financial Regulation for the revenues and expenditures of the Council. To resolve differences for the settlement of claims payments between service providers and insurance companies. The development of standards of medical service necessary for the health insurance companies to respond quickly to service providers bear the costs of treatment. To grant exceptions to the health insurance companies to contract with non-Saudi physicians for the purpose of monitoring the compliance requirements of service providers within the treatment cost-effectiveness. Examine complaints that arise between the parties to the relationship of insurance and forwarded to the Commission violations of the system. Collect the value of financial sanctions for breaching the provisions of the health insurance system. Determine the technical provisions recognized in coordination with other regulators and insurance companies are obliged to them. Supervision of the Cooperative Health Insurance Fund based on converting part of the surplus of insurance, calculated in the light of the results of the insurance company. Review insurance premiums and permit approval for insurance companies on premium if different than the value of the premium made by the company in the Action Plan. Clarification and interpretation of the Regulations. Dissemination of public information about the activities of insurance companies are eligible. Publication of the tables and statistical data on health insurance in the UK each year. Second, supervision and control of insurance companies: Disqualification of the health insurance business in the following cases: ◦ disturb the qualification requirements of the insurance company. ◦ Do not use during rehabilitation (12) months. ◦ give the insurance company expressly for rehabilitation. ◦ the company had stopped the practice of the Company for (6) months. Protect the interests of the beneficiaries as it may deem necessary, such as the Secretariat to amend the plan of work of any health insurance company. To obtain from the other supervisory information, data, and that work on issues such as health insurance application forms used by the health insurance company in correspondence with the parties to the relationship of insurance. Review and audit of all health insurance companies under the jurisdiction of the Council and the demand from other regulatory bodies to do so. A reservation on any of the executives in any of the health insurance companies. Take action after reviewing the bringing of any malfunction of the other oversight responsibility for ensuring the solvency of the company and its capital adequacy and safety of its assets and its allocation and the technical ability to fulfill its commitment to the beneficiaries. To maintain the confidentiality of the information on the insurance companies are not used only for official purposes specified in the regulations. Third, supervision and control of service providers: Determine the fees for the adoption of health service providers. Determine the fees for exempt entities that have medical facilities of the insurance coverage or part of it. Proposal to pilot a service contract between service providers and insurance companies. Identify requirements that should be available at the health facility, to maintain quality of health services provided in cooperation with the government health institutions with the capacity. Control standards provide the requirements of quality and commitment of the service provider contract (by Secretariat), a special consultant with the Office to assess the extent of its commitment to quality requirements. Assessment of health and service contracts between insurance companies and providers of services and monitor the compliance of the contracts to maintain quality controls. Revoke the accreditation of service providers in the following cases: ◦ withdrawn the license of the facility by the Ministry of Health. ◦ lack of commitment to the service provider contracted by the Office of the Secretariat, with a specialist to assess and measure the extent of his commitment to the requirements of quality more...



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