Medical malpractice insurance specialist Tego Insurance has introduced an in-house claims management team designed to enhance efficiency and improve outcomes for clients.
This team includes legal and claims professionals with expertise in healthcare, marking a shift toward more specialised claims handling.
The initiative follows Tego’s adoption of the Five Sigma AI-native claims platform earlier this year. The platform, implemented in August, was the first of its kind in Australia’s medical malpractice sector and has helped the insurer reduce claim cycle times and improve operational performance.
CEO Eric Lowenstein stated that combining advanced technology with an internal team demonstrates the company’s commitment to delivering high-quality claims management for both policyholders and broker partners.
“This move improves the efficiency and effectiveness of handling claims by ensuring our clients have direct access to experienced claims experts who understand the nuances of healthcare malpractice,” he said.
The new team handles claims from start to finish, including assessment, investigation, resolution, and closure. External legal counsel will be engaged when needed for more complex matters.
Tego also maintains its 24/7 medico-legal hotline to provide healthcare professionals with immediate expert guidance, ensuring comprehensive support throughout the claims process.
Lowenstein said this change improves resolution times, enhances communication, and ensures clients feel supported during what can often be a stressful experience.
The launch of the in-house team was marked by Tego’s annual retreat, which Lowenstein described as an opportunity for staff to collaborate and reflect on innovations and operational improvements.
The launch of Tego’s initiative comes as Australian health insurers call for national reforms.
Members Health Fund Alliance recently released a report calling for reforms to enhance the affordability and accessibility of private health insurance in Australia.
The report highlighted the contributions of its 24 member insurers, which provide coverage to 5.3 million Australians, including more than one million in rural and remote areas. Collectively, these funds account for a significant portion of the not-for-profit health insurance market, contribute $21.8 billion annually to the economy, and support over 155,000 jobs.
Matthew Koce, CEO of Members Health, said the sector has played a vital role in supporting Australia’s healthcare system and economic resilience.
The report outlined four policy recommendations aimed at improving the affordability of private health insurance while alleviating pressure on the public healthcare system:
Koce emphasised the importance of empowering consumers with better access to healthcare information.
“We want health insurance members to be in control of their healthcare, and that can only occur if consumers are empowered with access to information on price and performance of healthcare providers,” he said.
