Afcacia

In a rapidly digitizing world, where efficiency and customer satisfaction are paramount, traditional insurance models are struggling to keep pace with modern demands. Manual claims processing, outdated risk assessments, and inefficient customer interactions have long been challenges for the industry.

However, Kenya’s M-TIBA, under the stewardship of Managing Director Pieter Prickaerts, is revolutionizing the insurance sector with its cutting-edge real-time data analytics platform.

In an exclusive interview with global tech journalist Faustine Ngila, Prickaerts sheds light on how M-TIBA’s technology is redefining the landscape of health insurance. This groundbreaking conversation dives deep into the platform’s advanced analytics, machine learning capabilities, and its transformative impact on the insurance ecosystem. Here’s the interview excerpt, edited for clarity:

1. How does M-TIBA’s real-time data analytics platform revolutionize the way insurance companies process claims?

Inefficient and manual claims processes are leading to long approval times, high costs, and delays in payments to healthcare providers. M-TIBA’s real-time analytics and automation capabilities enable insurers to address these challenges by streamlining the entire claims process through digitizing and automating the entire insurance value chain, significantly boosting their efficiency and profitability. By processing claims in real-time, M-TIBA reduces payment cycles by up to 96% while cutting administrative costs by 80%. Efficiency improvement allows insurers to focus on reaching new, underserved customer segments and improving client satisfaction.

2. What specific machine learning algorithms does M-TIBA employ to predict insurance fraud patterns?

M-TIBA leverages advanced machine learning models to automate over 40% of claims approvals, significantly reducing assessment time from weeks to seconds. The machine learning models, tested over three years, digitally reviews and automates claim approvals without requiring manual review for each submission. This streamlines the claims assessment process, allowing assessors to focus on more complex evaluations. The algorithms are never allowed to automatically decide to reject a claim or treatment – they only provide for auto-approving when the conditions are met. This means that, when the algorithm is in doubt, human claims assessors continue to apply their skills and judgement – just as usual – to ensure all ethical standards are followed. The benefits extend to the insurer, its healthcare provider network and its members, with faster claim approvals leading to improved cash flow for providers and more affordable health insurance products for customers.

3. Can you explain how M-TIBA’s technology helps insurance companies improve their risk assessment models?

M-TIBA’s platform provides insurers with real-time, granular insights into patterns, trends and healthcare costs. This capability gives insurers a more accurate picture of claim trends, outcomes, and emerging risks, allowing them to make better-informed decisions. By leveraging these insights, insurers can shift from reactive risk management—where decisions are based on outdated or inaccurate data—to a more proactive approach. This, in turn, leads to better premium pricing and more sustainable and targeted insurance offerings.

4. In what ways does M-TIBA’s data-driven approach contribute to reducing operational costs for insurance providers?

Operational inefficiencies, such as manual claim processing and verifications, are high operational cost drivers for insurers. M-TIBA’s technology digitizes and automates end-to-end processes for insurers, reducing human intervention and the associated administrative costs. The platform enables insurance providers to make data-informed decisions to streamline internal processes further and allocate resources more efficiently.

5. How does M-TIBA’s system enable insurance companies to offer more personalized products and services to their customers?

M-TIBA’s system empowers insurers to offer more personalized products by providing actionable insights based on real-time data. For example, insurers can develop tailored offerings like SwapCare, an embedded insurance product that’s personalized to the specific needs of electric vehicle drivers, that was recently launched by one of our partners. Through our platform, our payer partner was able to underwrite a product where electric vehicle riders are automatically covered whenever they swap their batteries at a partner outlet stations, addressing the unique risks of this occupation in an easy and accessible way. Based on insights by the platform, insurers can launch and manage highly relevant, personalized products that resonate with the needs of underserved segments. This ensures insurance solutions are not only cost-effective as the pool is wider but also closely aligns with the actual needs of the insured, leading to better customer satisfaction and experience.

6. What role does M-TIBA’s real-time data analytics play in streamlining the underwriting process for insurance companies?

M-TIBA’s real-time data analytics transforms the underwriting process by providing insurers with instant access to detailed, actionable insights. By utilizing anonymized, granular data, underwriters can assess risk more accurately and efficiently, moving beyond outdated, static data sources. With real-time monitoring of healthcare utilization and treatments, insurers can better predict and tailor their policies to meet members’ needs. This approach not only speeds up the underwriting process but also ensures that premiums are set more precisely, creating a balance between risk and cost.

7. How does M-TIBA’s platform facilitate better decision-making for insurance executives through data visualization?

In today’s fast-paced business environment, insurance executives need clear, actionable insights to make strategic decisions. However, accessing these insights can be challenging, as the data insurers collect must be organized and interpreted—a process that often takes time. M-TIBA’s platform simplifies this by translating complex datasets into intuitive, real- time dashboards with actionable insights. From monitoring loss ratios to analyzing claim trends and detecting fraud, executives can quickly identify key performance indicators (KPIs) and areas needing improvement. This empowers leadership to make data-driven decisions that enhance profitability, optimize resource allocation, and drive innovation throughout the insurance value chain.

8. Can you discuss the impact of M-TIBA’s machine learning capabilities on customer retention strategies for insurance firms?

M-TIBA’s machine learning capabilities, while primarily focused on improving the speed and accuracy of claims processing, also play an indirect but important role in customer retention for insurance companies. By automating and accelerating claims approvals, machine learning improves cash flow for healthcare providers, ultimately leading to higher customer satisfaction and trust in the insurer’s services. The improved accuracy in claims assessment means fewer errors and disputes, leading to a smoother, more transparent process that enhances the overall customer experience. When claims are handled efficiently and reliably, it increases customer confidence in their insurer, which is a key factor in long-term retention. Additionally, insurers can leverage these enhanced operational efficiencies to reinvest in customer-centric services, such as preventive care programs or more personalized products, further supporting retention efforts. In this way, M-TIBA’s technology contributes to more satisfied, loyal customers by improving the core aspects of the insurance experience – reflected in M-TIBA’s Net Promotor Score (NPS) of 60+ for member satisfaction.

9. How does M-TIBA’s technology help insurance companies in identifying and targeting new market segments?

M-TIBA partners with insurance companies to expand healthcare access to underserved, uninsured segments, helping improve financial health across communities. By focusing on individuals, M-TIBA enables innovative, personalized insurance products—from digital embedded insurance to solutions tailored for informal work risk or income replacement. Through streamlined, automated processes and close integration with key stakeholders, M-TIBA makes it easier and more cost-effective for insurers to reach and engage new markets. Our technology empowers insurers to educate people on insurance in an innovative way, while also facilitating affordable, targeted offerings, such as micro-insurance products that eliminate out-of-pocket payments by settling bills directly with healthcare providers.

10. What measures does M-TIBA implement to ensure data security and privacy while processing sensitive insurance information?

Data security and compliance is at the core of M-TIBA’s platform. The platform meets stringent global standards like GDPR, ensuring transparent, high-quality data insights while protecting the privacy of its clients. The platform enhances security by leveraging a Personal Identifiable Information (PII) data vault that anonymizes data and makes it securely accessible to drive decision-making. Insurers benefit from faster processes and a strong data security foundation. It’s a key step in ensuring streamlined and secure operations. In addition, M-TIBA is ISO certified for our Information Security Management System (ISMS).