Insurance Management Systems

Sapashe Group Limited offers a next-generation Insurance Management System that integrates health insurers, healthcare providers, and patients on a single, secure digital platform. This system is designed to automate and optimize the complete claims lifecycle from beneficiary enrollment to eligibility verification, claims submission, and reconciliation all while adhering to regulatory standards and ensuring full transparency.

Key Features & Capabilities:

• Eligibility & Enrollment Management
  Simplify how patients and beneficiaries are enrolled, verified, and managed in the system. Our IMS supports multiple scheme types and benefit structures, making it appropriate for both public and private health payers.
• Claims Administration
  Automate health-claims processing across the full cycle: submission, adjudication, payment, and reconciliation. This reduces administrative overhead, minimizes errors, and speeds up turnaround times for both payers and providers.
• Policy & Plan Configuration
  Support flexible insurance policy design including benefit packages, co-payments, deductibles, and tiered coverage enabling payers to design customized insurance plans.
• Provider Network Management
  Manage providers, hospitals, clinics, and pharmacies including credentialing, contract terms, pricing, and network coverage through a centralized system.
• Integrated Clinical Services
  Access clinical decision support capabilities such as e-prescribing and referrals, helping providers ensure that care is both appropriate and cost-effective.
• Data Analytics & Reporting
  Leverage comprehensive reporting dashboards and analytics to monitor operational performance, financial metrics, fraud indicators, and claim trends helping payers and regulators make data-driven decisions.
• Real-Time Payment & Settlement
  Facilitate real-time or near real-time settlement between payers and providers, improving cash flow, reducing delays, and enhancing trust across the healthcare ecosystem.
• Regulatory Compliance & Governance
  Ensure that data exchange, claims formats, and workflows comply with insurance authority regulations, industry standards, and local requirements. The platform offers audit trails, data validation, and role-based access control.
• Scalable Deployment
  Deploy the system in the cloud, on-premises, or using a hybrid model — with flexibility to scale as your insurance scheme and transaction volumes grow.

Why Choose Sapashe’s Insurance Management System

• Efficiency & Cost Reduction
  By automating key insurance processes, Sapashe helps insurers and healthcare payers significantly reduce administrative costs while accelerating claims turnaround.
• Improved Transparency
  With seamless integration across payers and providers, the system gives all stakeholders greater visibility into claim status, payments, and beneficiary data increasing trust and reducing disputes.
• Better Patient Experience
  Patients benefit from faster claim approvals, transparent communication, and simplified enrolment all delivered through a modern, user-friendly platform.
• Strengthened Fraud Prevention
  Advanced data analytics and real-time validation help detect and prevent fraudulent claims, protecting payers and maintaining system integrity.
• Regulatory Alignment
  Built with compliance in mind, this system supports adherence to Kenya’s regulatory frameworks, enabling insurers and providers to meet statutory requirements without compromising efficiency.
• Scalability & Flexibility
  Designed to grow with your insurance business, Sapashe’s IMS adapts to increased volumes, additional providers, and evolving healthcare schemes.