CEO & Board Member
A regular day at a TPA is like being in a no man’s land, bombarded from all sides. Hospitals, clinics, and pharmacies seek approvals for tests and treatments as well as payments. Sick patients clamor to know why care requests are being turned down. Regulators issue new guidelines and product lists. Insurance and reinsurance companies keep an eye on how much of the policy, is used, how and why, and brokers and corporates look for the best possible deal for their clients, and of course, everyone needs everything, yesterday.
However the payoff, Anil Nair, CEO, IRIS Health Services said that it depends on the lives impacted, health improved, burdens eased, trust gained and the resources saved for every individual and every organization served.
“TPAs are like the hidden figures, the unsung heroes, of the health insurance sector,” says Nair, a health insurance veteran for more than 15 years. “Virtually no one outside of the industry has even heard of a TPA, let alone understands what it is we do until they need to interact with us.”
If the health insurance sector were a jigsaw puzzle, TPAs would be the center piece, connecting every other piece in the healthcare ecosystem. They manage health insurance policies on behalf of insurance companies, businesses, and individuals, liaising with healthcare providers and policyholders to provide better access to medical care and ensure better health outcomes for all. TPAs like IRIS manage specialized insurance needs for reinsurers, regulators, and self insured companies.
“For us, it’s the lesser seen wins that keep us going: the relief of a patient or a family when they’ve been able to get the care they need in time, the positive feedback from frontline medical professionals when we’ve saved their time and energy, from the communities and companies, who benefit when we’re able to eliminate fraud and waste and save precious resources for the future.”
From its humble beginnings in 2014, IRIS Health Services has grown exponentially. Today, it serves more than 400,000 insured members in the UAE alone from its corporate headquarters in Dubai and branch office in Abu Dhabi. That’s not counting clients served in Oman, the Far East, and South Asia: Not bad for a company of fewer than 100 people.
CEO Nair takes pride in the startup’s reputation as an outlier in a crowded, competitive industry. IRIS is known for being upfront,for doing things differently and for being counter culture a small fish making an impact in a big pond.
Clients, members, and the industry a like have recognized IRIS’ work and practices. In March 2019, IRIS received the ‘Innovation of the Year’award at the Etisalat SMB Awards in Dubai, the latest in a string of accolades. Other recent awards include being named ‘Most Innovative Service Provider’ at the MENA Insurance Review Awards 2018 and ‘Most Innovative Insurance Claims Software 2018’ from International Finance magazine.
Iris health services is a mediator that processes the claims and settlements between policy providers and policy holders
It’s not enough to have the right people, he said, in an age of outsourcing and remote work, those people must be accessible. IRIS is one of the few or only TPAs in the UAE to have a full team of in-house medical doctors to screen claims, and certainly one of the only to have a 24/7 multilingual call center and help desk based in the country.
Team IRIS Health Services
“Our team and our clients are our strength. Without the hard work of our team, and the faith and trust of our clients, we could have never been able to create this kind of impact in the market,” Nair adds.
Innovation is also a red-hot area of strength. IRIS’ proprietary, cutting edge online knowledge management suite Ezyclaim is a game-changer in health insurance claims circles. It gives clients the ability to monitor health insurance usage in realtime, detect trends, monitor for fraud, review performance, and manage their portfolios with unparalleled efficiency and transparency.
(L-R) Anil Nair (CEO), Dr.Ann Jacob (COO) & Sujith Menon (VP-Client Services)
IRIS is designed and built the platform from scratch, but it isn’t the last brainwave from their stable. The company is already integrating AI, blockchain, and other emerging technologies into its processes and platforms to realize wins across the board for all its stakeholders. It’s also investigating what technologies like facial recognition can contribute. “It’s not only about improving efficiencies a good goal in itself but it’s about closing the gaps, about engineering a seamless experience for all involved, resulting in better treatments, accurate and faster adjudications, reduced wait times, better utilization of limited resources, better outcomes and healthier risk,” Nair explains.
A continuous improvement mindset is also a key driver of IRIS’ success. The company is ISO 9001:2008, ISO 27001:2013 and ISO 26001 certified, meaning it conforms to the highest standards of information and data security, patient health information confidentiality, and social responsibility. IRIS chose to pursue the Committee on Operating Rules for Information Exchange (CORE) Endorser Seal, a U.S. standard that sets the bar for patient confidentiality and data security, making it the only company in the GCC to do so.
“The world is growing increasingly smaller,and advances happen almost overnight,” says Nair. “We will not only survive but thrive by continuing to think different, act different, and be different.”
IRIS constructs services that best fit the everchanging market trends and requirements. The wide range of services includes Claims Adjudications, Portfolio Analysis & Management, Business Process Outsourcing, Insuretech Solutions, Medical tourism, and Wellness Solutions, among others.