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Solutions · Medical Schemes

AI automation for South African schemes.

Three solutions that cut call centre volume, automate claims processing, and retain more members — without adding headcount.

Member AI & Benefit Navigation

Give every member instant, accurate benefit answers via WhatsApp — in plain language, in seconds, without calling your call centre. Available in all 11 SA official languages.

  • WhatsApp
  • 11 Languages
  • Benefit Queries
  • 24/7 Availability

Claims & Pre-Auth Automation

Automate pre-auth triage, resolve routine claims exceptions without human review, and cut processing backlogs. Built for SA schemes running on Rx20, Rx30, or proprietary systems.

  • Pre-Auth Triage
  • Claims Exceptions
  • Rx20
  • Rx30

Gap Cover & Retention Intelligence

Automate gap claim submission, predict member lapse before it happens, and intervene with personalised outreach. Turn retention from reactive to proactive.

  • Gap Claims
  • Lapse Prediction
  • Member Retention
  • AI Outreach