The TPA and Assistance segments are labor intensive and operationally complex fields, requiring skilled, well trained, costly human resources. Case resolution typically involves 14 manual touchpoints and many more internal interactions. Most of the policy-service touch points are non-client-facing administrative and financial tasks
The overwhelming majority of medical cases managed by Assistance firms and TPAs (80%-90%) are “Small Claims”. “Small Claims” are defined by payers and TPAs as provider charges no greater than US$2K, typically for ambulatory medical services. Moreover, most “Small Claims” are in the range of US$300.00-$800.00.
These small medical claims generate low-margin revenue that is sharply contrasted by high cost of service and limited productivity of Assistance agents. As such, scalability of policy-servicing operations is limited and requires significant capital to support matching growth in fulfillment volume.
AssisticaMD® changes this paradigm by injecting automation that allows scalability without capital. It also allows Assistance and TPA companies to redeploy their staff towards larger, profitable, claims.
In a post-Covid-19 business environment that will see unprecedented growth in sales of international medical travel insurance, AssisticaMD® is an optimal solution.
A ten-year veteran of the IT space, Jorge is an effective IT system analyst and seasoned developer who excels in translating vision to technological innovations. Jorge has nurtured AssisticaMD® from a mere vision to a market ready product and remains in charge of its continued development and operations support.