Transparency is an important differentiator in any sector. In the case of health insurance contracts, it is essential, since the care offered is for the maintenance of life.

In view of this, it is important that both the plan operator and the beneficiary seek to clarify all the services and benefits guaranteed so that both can establish a relationship of trust based on transparency and the quality of the services provided.

So, you're a health insurance manager? Do you want valuable information that can help you in your management? Be sure to check out this post, after all, it's been prepared for you!

Do you know why transparency is fundamental for health insurance?

Transparency is a highly necessary measure for both sides, as it makes it easier to understand the criteria and procedures adopted. This way, stakeholders can plan ahead and avoid unpleasant surprises.

The good manager broadens his vision around what pleases the consumer. However, they understand that acting transparently, offering qualified services with a guarantee and provenance, is what can boost their company and win consumer loyalty.

The health plan you want is the one that guarantees transparency and personalized services in your contract. These requirements can make a difference when they are analyzed seriously and with respect for the consumer.

Managers must be aware of all these requirements and adapt them to the reality and needs of their clients, showing clarity in the disclosure of the waiting period and coverage of their health plan, providing information on readjustments and keeping clients well informed in order to avoid surprises, misunderstandings and, consequently, the cancellation of plan contracts and the search for new services.

Operators are required to disclose the indices used by means of a statement sent to the contractor in advance, respecting the stipulated and negotiated clauses, with the aim of replacing the variation in medical and hospital expenses and guaranteeing the financial balance of the health plan portfolio.

Learn about the challenges faced by health plan managers

The health insurance market is currently facing a number of problems, such as a significant reduction in beneficiaries - a situation that can be reversed with proficient management that knows how to dialog and negotiate with its beneficiaries in a practical and transparent way. Beneficiaries like to be informed, and this fosters their perception of transparency, since they want to know what is and isn't their right.

It's important to note that today's world is very competitive, which makes the challenges even greater, since the consumer has various possibilities to change operator and secure the services you want.

Therefore, the health contract manager must have the knowledge and skills to transform problems into growth possibilities for their company, in other words, managers and operators need to reinvent themselves in order to maintain their activities efficiently. This is an almost constant challenge for the manager.

Find out what the biggest complaints from health insurance beneficiaries are

According to the Brazilian Institute for Consumer Defense (Idec), the health insurance contract sector was the big champion of complaints last year. According to the survey, complaints about health operators amounted to around 23.4% in 2017. This figure puts the sector in the complaints ranking for the third year in a row. This is yet another challenge for health insurance managers.

According to Idec, the majority of complaints are directly linked to abusive plan increases without coherent justification, especially for group and corporate plans. There are also complaints about lack of coverage, in other words, lack of transparency is the main source of complaints.

These are complaints that can lead to even greater complications for health insurance providers, since the dissatisfied beneficiary can cancel the contract, disclose information about the provider's conduct and lead to a loss of credibility and often even lawsuits - a harmful attrition for providers.

The question arises: is it worth going through all this? Isn't acting with competence and transparency more interesting?

Here are some viable strategies to adopt in your management

Some of the challenges that managers of health insurance contracts have to overcome are conflicts and maintaining good relations, both with beneficiaries and with the National Supplementary Health Agency (ANS - Agência Nacional de Saúde Suplementar). ANS.

In addition to ensuring user satisfaction, managers should be concerned about the rate of IDSS and propose actions for disease prevention and health promotion, meeting a requirement of the new health paradigm, offering more humanized treatment of others. Here are some important practices to improve your management!

Adoption of service indicators

Health plan managers looking for better results must adopt strategies to define service indicators, implementation, measurement and data analysis.

More than just complying with ANS rules, the indicators must be based on the operator's strategic positioning, its mission, its values and its purpose as a company. Managers need to have a clear policy and offer quality services in a precise manner, guaranteeing the well-being of their users.

Valuing professional qualifications

Health insurance contract managers can achieve good results with the contribution of their employees. It is essential that each member of the team is encouraged to develop their potential with clarity about their activities, autonomy to streamline processes and incentives for professional qualification. As well as generating good results, this promotes a more welcoming and, consequently, more productive environment.

Humanizing care

Welcoming and empathetic care is a differentiator. However, the managers of health insurance companies can't give up on more humanized and faster services through software and technologic solutions that optimize processes and speed up results.

Measuring results

All the effort will be useless without analyzing the development of each action taken. It is important to share the results with the team.

Innovation in health

There are currently several trends in the healthcare sector, such as Business Intelligence, Pay for Performance, Big Data and Incentives for Patients. In addition to these, there is also design thinking, a methodology applied in healthcare to detect errors in processes. Invest in your knowledge and become a proficient professional.

Despite all the possibilities, it's important to understand that the financial management of health plans is complex and requires budget planning, prospective risk analysis and even auditing, i.e. there are several steps that need to be taken to eliminate errors.

Adopting a medical accounts system is interesting for ensuring the financial health of a supplementary health plan, since it is specific and enables direct contact with suppliers, making audits possible and improving your work.

Throughout the text, we've given you several pointers on the importance of transparency in health insurance contracts, as well as tips for improving your management and taking your company to a place of excellence in such a competitive market.

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