Modern health insurance benefit assessment

A modern benefits verification process allows for more precise, efficient, and streamlined handling of benefit applications, whether through pre-approved cost authorizations or subsequent invoice validation. By preventing unjustified benefit costs, enhancing automation rates, and offering increased transparency and traceability, insurers can significantly improve customer satisfaction. Ultimately, this drives the competitiveness of health insurance providers in an increasingly digital and interconnected marketplace.


Are you asking yourself

  • What impact do new or modified contractual or regulatory agreements regarding medical reimbursements have on your audit rules and processes (e.g., TARDOC or outpatient flat rates in Switzerland)?
  • Are you able to provide cost assumption guarantees with system support and later compare them with the actual claims? Is it also possible to automate this process?
  • How can you optimize scanned claims to further increase the straight-through processing rate across the entire claims workflow?
  • How do you achieve performance evaluation that extends beyond operational monitoring to active management and organizational improvement?
  • How do you design a rule set that is both lean and maintainable, applicable for cost reimbursement applications, invoice verification, and fraud detection?

What you can expect from us

  • Expert Support with Extensive Industry Knowledge
    Benefit from our deep expertise in benefits management for UVG and KVG/VVG insurers, ensuring competent and reliable guidance.
  • In-Depth Knowledge of KVG/KLV Regulations and Digital Solutions
    Our team has proven expertise in KVG/KLV laws, tariff structures, processes, and the latest digitalization solutions and trends.
  • Tailored Consultancy and Process Methodology
    We offer personalized consultancy, providing support in implementing the process methodology that best fits your organization's needs.
  • Comprehensive Experience in Test Control Systems
    With broad experience in the development and operation of test control systems, we bring both conceptual and technical knowledge, including parameterization expertise.
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Our Approach

  • Health Check / Initial Analysis

    We offer a concise health check or, as an initial step in your project, conduct a joint analysis of your current situation and key challenges.

  • Deep Dive into Key Areas

    Through specialized workshops, questionnaires, and leveraging our procedural and technical expertise, we identify key areas of action and develop a tailored set of recommendations.

  • Advisory on Implementation and Methodology

    Drawing on our extensive experience and industry benchmarks, we provide strategic advice on project design and the most effective implementation approach.

  • Implementation Support

    Our Synpulse implementation specialists assist with project management, solution design, and provide expert technical and subject matter support in areas such as tariff and rule maintenance, as well as operational organization and processes.

Let's get in touch

  • Questionmark

    1. Tell us your needs

  • Hi

    2. Meet with us

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    3. Get a tailormade offer