M-TIBA

Health insurance technology platform connecting payers, providers, and members across Africa

Core Administration Growth Seed

Overview

M-TIBA is a health insurance operations platform for insurers, governments, and donor-funded health programs in sub-Saharan Africa and the Middle East. The company provides end-to-end insurance administration technology that connects payers, healthcare providers, and members via mobile infrastructure, reducing the cost of managing a health insurance portfolio.

The platform delivers automated pre-authorization, real-time claims processing, fraud detection, member management, and a provider network portal. Delivered as SaaS and integrated with M-PESA for mobile money payments, it reduces administrative cost per member from approximately USD 29 to USD 1 annually, and cuts claims turnaround from 77 days to under three hours. The system supports micro-insurance schemes designed for low-income populations alongside commercial health portfolios.

M-TIBA serves 20 payers across Africa and has processed coverage for over 4.8 million lives. Customers include Jubilee Health Insurance, AAR Insurance, and RGA. The company holds ISO/IEC 27001:2013 certification and received Blue Company Certification in August 2025 for ethical business standards. M-TIBA was originally formed as a joint venture between CarePay International and PharmAccess Foundation.

Products & Services

Member Experience Platform

A branded mobile application for insurance members providing real-time claim status, instant benefit verification, and digital insurance ID cards. Members access health benefits via mobile, reducing manual calls and improving engagement.

Key Features

Real-time claim visibility
Instant benefit checks
Digital member ID cards

Target Users: Health insurance policyholders and scheme members

Connected Operations

Automated workflows for pre-authorization and claims processing, including straight-through processing and real-time fraud detection. The system reduces manual intervention in claims handling.

Key Features

Automated pre-authorization workflows
Straight-through claims processing
Real-time fraud detection
Reported 80% reduction in claims handling costs

Target Users: Health insurers, managed care organizations, government health agencies

Data & AI Layer

Analytics capabilities for actuarial pricing, portfolio cost monitoring, and risk management. AI-driven tools help insurers optimize pricing decisions and detect anomalies in claims data.

Key Features

Real-time actuarial analytics
Cost monitoring dashboards
AI-assisted pricing optimization

Target Users: Actuaries, portfolio managers, chief underwriting officers

Claims Management Dashboard

A case management interface for claim processors and operations staff to manage workflows and track resolution status.

Key Features

Workflow management for claims staff
Portfolio performance tracking
Reported 500% increase in daily claims processing capacity

Target Users: Claims teams at health insurers and TPAs

Provider Network Portal

Digital portal for healthcare providers enabling eligibility verification and pre-authorization submission.

Key Features

Digital eligibility checks
Pre-authorization request submission
Provider network onboarding

Target Users: Hospitals, clinics, and healthcare providers in partner networks

At a Glance

Founded: 2015
Headquarters: Nairobi, Kenya
Employees: 51-200
Funding: Seed

Category & Focus

Category: Core Administration
Subcategories: Claims Management Member Administration Provider Network Management
Insurance Verticals: Health
Target Customers: Carriers, TPAs