Claims agent for medical aids
A ready-made Health Loops agent that answers “why do I still owe this?” without a call centre queue.
Coastline Medical SchemeClaims agentWhatsApp
- Customer: Why do I still owe R640 on this?
- Read statement dated 3 OctoberDiscovery Health
- Claims agent: Your scheme paid R1,560 of the R2,200 specialist bill, at the scheme’s rate. The R640 left is the specialist charging above that rate. You could ask the rooms if they’ll accept the scheme rate.
- Customer: Can you ask them?
- Claims agent: I can draft the message for you to send, with the claim details. Want it?
What it does with your systems
- Explains Discovery Health statements line by line and chases missing claim documents
- Takes statements and documents on WhatsApp, including photos
- Takes statements and documents on Email, including photos
- Takes statements and documents on Voice and phone calls, including photos
Questions
What is a claims agent for medical aids?
A ready-made Health Loops agent that answers “why do I still owe this?” without a call centre queue.
Does the claims agent change claim outcomes?
No.
Can members send a photo of a statement?
Yes.
Where do the agent’s answers about benefits come from?
From the scheme’s own published plan guide for the member’s option, and from statements the member sends.
Ollie’s agents give wellness guidance. They don’t diagnose or prescribe, and hand off to a human expert when needed.