Background: QLM Life and Medical Insurance is considered as the largest health insurance company in Qatar and the only specialized company that leads the health insurance sector through its advanced services and flexible insurance programs that suit all segments of society in Qatar.
We live in a world that has become highly dependent on information technology in management, especially with managing a large volume of data, as is the case in health insurance. Therefore, our vision in this field was to develop a system capable of absorbing any volume of data and managing it effectively in the most efficient way possible. This will, in turn, positively reflect on the speed of responding to the requirements of our customers and the requirements of medical service providers at the same time.
The advancement of technology benefit both insured members and insurance companies; QLM is no exception. QLM is constantly innovating and growing; we capitalized on the extensive data, experience, and technology advancement to build an outstanding insurtech to guarantee excellence in our services. At the same time, it gives us a real time feedback on operations. The development of our solutions was highly sophisticated as it involved many parties internally as well as externally. We’ve invested in developing a highly sophisticated solution involving both internal and external parties.
We managed to build a system through an interactive electronic platform that automatically approves without the need for human intervention except in rare cases, which shortens the time for issuing approval to a record time where the patient experiences a seamless process. This electronic platform helps health centers communicate, get the right information, and make the whole transaction an easy journey for both parties. All this is in the interest of the client/patient, who will feel that they are receiving prompt and a high standard of service.
Today, our systems are all online and fully integrated with healthcare providers inside as well as outside Qatar; the provider can at a fingertip verify eligibility, obtain approval, and submit a claim all online without the need for any direct interaction with our team. The secret behind this is the claims auto-approval/auto-adjudication; our systems are equipped with all international medical coding that are mapped together in the back end of the system. Therefore, any coding the provider is using is mapped and auto adjudicated in the back end, and the decision is communicated to the provider by the system.
The crown jewel of our IT platform is the Artificial intelligence (AI) that we have developed. Underwriting in health insurance is always seen as risky and needs extra attention; our AI module analyzes the data provided by the client and, at the same time, analyzes the existing QLM data measuring behavior, trend, frequency, etc. Thus, suggesting an appropriate premium with the prediction of a loss ratio based on the suggested premium.
Our AI is constantly monitoring the behavior of providers in real-time and alerting our team of any abnormal behavior that is taking place; it is monitoring the auto-adjudication module and correcting any errors that may exist during the process.
We are constantly evolving and growing as the leading Medical and Life insurer in Qatar; as we rely heavily on tech, we will continue investing where appropriate to maximize the satisfaction of all our partners. In QLM, we believe that insurtech is the present and future. We will continue playing our role and assessing the markets worldwide while simultaneously be at the forefront when it comes to tech and for others to follow.
