Solutions
Health & Medical Insurance Software
Medical insurance is claims-intensive and rule-heavy. Ontech manages members and dependants, configurable benefit structures and limits, provider claims capture and adjudication against benefits, and fraud controls that protect scheme sustainability.
Definition. Health insurance software administers medical schemes — members and dependants, benefit structures and limits, provider networks and medical claims adjudication.
What medical scheme administration requires
Health cover turns on benefits: what is covered, up to what limit, for whom. The system adjudicates each provider claim against the member's benefit structure and remaining limits, applies co-payments, and flags anomalous billing patterns for review.
Capabilities
- Member and dependant administration
- Configurable benefit structures and limits
- Provider claims capture and adjudication
- Co-payment and limit enforcement
- Medical claims fraud detection
Business benefits
- Accurate benefit-based claims adjudication
- Reduced medical claims fraud and leakage
- Sustainable scheme performance
Frequently asked questions
How does health insurance claims adjudication work?
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See the platform on your data
Talk to the Ontech team about deploying the Enterprise Insurance Operating System for your business in Zambia.
Last reviewed: 2026-07-29