The operating platform that protects your loss ratio.
Clean claims go straight through. Fraud, waste and abuse are caught at the point of decision, not in a report after the money has left. Safety-gated AI, with a human on every exception.
Multi-tenant · 3,388 geocoded Nigerian providers · NHIA-aware tariffs · NDPA 2023 aligned
Margin leaks through the claims process.
Nigerian HMOs lose margin to manual claims vetting, to fraud, waste and abuse, and to slow pre-authorisation turnaround.
Manual claims vetting
Reviewers read every claim by hand. Clean claims wait in the same queue as the ones that need real scrutiny, and cost follows delay.
Fraud, waste and abuse
Duplicate billing, upcoding, and diagnosis mismatches pass through unseen when detection depends on the memory of individual assessors.
Slow pre-authorisation
Authorisation decisions arrive after the fact. By the time a pattern is visible in a report, the spend has already happened.
One platform across the HMO value chain.
Three modules do the margin work. Everything else runs on the same member and claims model, so a decision made in adjudication is visible everywhere it matters.
Claims and adjudication
Rules-first automation routes clean claims straight through and sends only exceptions to human reviewers.
Fraud, waste and abuse detection
Pattern detection across providers, prescriptions, and diagnosis mismatches surfaces what individual review misses.
Pre-authorisation and provider steering
Real-time clinical routing at the point of authorisation, not retrospective reporting after the spend.
The operating foundation
Enrolment and member management, pharmacy benefits, distribution, and analytics run on the same member and claims model. Full value-chain coverage, without a second system to reconcile.
Architecture your technical team can trust.
Four commitments, stated plainly, for the technical team that arrives second.
True tenant isolation
Every tenant's data is isolated at the database layer with row-level security. No shared visibility, ever.
Humans stay in the loop
Automated adjudication operates behind a hard accuracy gate. The platform will not deny a claim automatically beyond a strict false-denial threshold. Exceptions go to people.
Integer kobo, end to end
All monetary values are processed as integer kobo throughout. No floating-point money, no rounding drift.
Append-only event log
Every state change is recorded in an append-only event log before it takes effect. Nothing is edited in place.
Made for this market, not adapted to it.
Ajé is built exclusively for Nigerian health insurance, from the regulatory posture down to the channels members actually use.
Regulation-aware by design
An NDPA 2023 aligned data protection posture, with NHIA-aware reporting and tariff structures built in.
Nigerian payment rails
Premium collection and payouts through the rails you already use, including Paystack and NIBSS-connected flows.
Where members actually are
Member engagement is WhatsApp-first, with SMS and USSD support so feature phones are never left out.
Calibrated to the local burden
AI tuned to the Nigerian disease burden, including malaria, hypertension, and diabetes, never Western datasets.
Stated plainly, held strictly.
Encryption everywhere
Data encrypted in transit and at rest.
Role-based access
Granular role-based access control.
Independent testing
Independent security testing before live data at scale.
Data protection programme
An active Nigerian data protection compliance programme.
See it against your own book.
We run a working session with your operations team, walking through adjudication, fraud detection, and pre-authorisation on the workflows you handle every day.
Request received.
Thank you. Our team will be in touch within one business day to arrange your working session.