When a traveller is seriously ill or injured abroad, effective support depends on coordination between insurers, assistance providers, hospitals, transport teams, and claims professionals. Every decision has the potential to influence patient outcomes, service quality, and cost, making alignment across the chain essential.

Against that backdrop, experts say onboarding needs to go well beyond policies and role descriptions, focusing instead on how the entire system connects – and how each function shapes outcomes for colleagues, partners, and customers. Across the board, they point to recurring priorities: cross-functional understanding, scenario-based learning, continuous development, and a consistent focus on the patient at the centre of every case.

Where onboarding most often falls short

For Huguett Herrades, Head of Providers and Claim Cost Control at MAWDY, the most common weakness in onboarding is its tendency to remain siloed and function-specific. She said: “In my opinion, onboarding in international medical assistance most often fails when training is limited to the specific functions of each role – such as call centre operations, medical coordination, provider network management, claims, medical cost control, or customer service – without explaining how all these areas interact within a real case.”

In real-world operations, she said, assistance work is rarely linear. Instead, it involves multiple moving parts and stakeholders interacting simultaneously, often under significant time pressure. “When employees do not understand how these roles interrelate – or the scope and limitations of each area – significant operational gaps arise,” she added.

Those gaps, she explained, are not abstract. They appear directly in case handling, often manifesting as delays in medical authorisations, duplicated or contradictory instructions, unnecessary escalations, increased operational costs, inconsistent clinical follow-up, and internal friction between teams. In more serious situations, she said, they can even lead to medical-legal exposure and a degraded customer experience.

When people understand the bigger picture, they make better decisions, communicate more effectively, and ultimately provide a better service

Herrades also highlighted a common conceptual misunderstanding that shapes early performance in new hires. “It is also common for new employees to misunderstand the difference between ‘assistance’ and ‘insurance’. Assistance operates under critical timelines, immediate coordination, and real-time decision-making, while traditional insurance is typically more focused on administrative processes and reimbursements.”

For her, addressing these challenges requires onboarding that reflects the reality of interconnected operations: “The most effective organisations address these challenges by implementing multidisciplinary onboarding programmes, including real-case simulations and short cross-functional rotations,” she said, arguing that exposure to multiple functions early on helped staff understand how their decisions affect the wider chain.

That broader industry perspective was echoed by Claudia Schmiedhuber, Founder and Chief Executive Officer of the Global Assistance & Medical Transport Institute (GAMTI), who said the issue often begins with how training itself is framed. “One of the biggest challenges we see is that people are often trained for their specific role, but not for the industry they are working in,” she said.

She explained that international medical assistance depends on constant interaction between insurers, assistance companies, transport providers, and medical professionals, yet new employees are not always given visibility of that wider structure. “Whether someone works in assistance, operations, aeromedical services, claims or management, they should have a basic understanding of how travel insurance works, how assistance companies operate, how medical transport is coordinated, and how all the stakeholders interact,” she said.

“When people understand the bigger picture, they make better decisions, communicate more effectively, and ultimately provide a better service,” Schmiedhuber explained.

Understanding both the system we operate within and the human impact of the work is what enables individuals – regardless of role – to contribute effectively from day one

For Deirdre Aspell, Training and Development Manager at Charles Taylor Assistance, the starting point of onboarding needs to focus on people rather than systems.

She emphasised that communication is one of the most critical operational factors in high-pressure environments, where small delays or misunderstandings can escalate quickly. “Excellent communication is key in this environment. Delays or missteps of any kind can have a lasting effect on our customers and their loved ones at what is often a highly vulnerable time,” she said.

That expectation extends beyond internal coordination to external partner engagement, where consistency and clarity are essential for maintaining trust. “Getting it right first time, every time, ensures a lasting positive experience for all,” she added.

From the hospital perspective, Ken Ho, Insurance Development Manager at Matilda International Hospital, highlighted how misalignment between stakeholders remains a persistent operational challenge, particularly in cross-border cases involving multiple organisations.

He explained that issues often arise from uncertainty around responsibilities and approval pathways: “This additional communication layer can sometimes contribute to delays, particularly in urgent or cross-border situations,” he said, noting that time zones, language barriers, and differing administrative classifications between healthcare systems add further complexity.

To address this, he emphasised the importance of structured onboarding for frontline hospital teams. “We have found that ensuring frontline staff thoroughly understand key insurance workflows, including pre-authorisation requirements, notification timelines, required documentation, and the respective roles of insurers and assistance providers”, helps reduce avoidable delays and improve continuity of care, he said.

Understanding the international assistance ecosystem

While contributors come from different parts of the sector, they consistently return to the same point: onboarding only works when employees understand the wider system they are operating within, not just their own function.

Herrades argued that this understanding needed to extend beyond operations into financial and structural awareness as well. “Every new hire, regardless of their role, should have a solid understanding of the operational and financial fundamentals of the international travel insurance and medical assistance ecosystem,” she said.

Equally important, she added, was recognising the human context behind every case. “Every employee should understand that clients are often in a vulnerable situation – ill or injured, abroad, facing language barriers, and under emotional stress. This significantly impacts how communication and decision-making should be handled.”

Aspell similarly highlighted the importance of understanding the full ecosystem of stakeholders involved in a single case. “There’s a lot that new hires need to take on, but one of the most important foundations is understanding the ‘who’s who’. We work in a highly interconnected industry – insurers, assistance providers, medical teams, and global partners – across different time zones and healthcare systems,” she said.

She agreed that this broader awareness enabled individuals to contribute meaningfully from the start. “Understanding both the system we operate within and the human impact of the work is what enables individuals – regardless of role – to contribute effectively from day one.”

Ho reinforced the importance of structured preparation within hospital environments, particularly where international patients are involved: “Effective onboarding and training are essential in helping hospital staff to understand the workflows involved in international medical assistance cases.”

He also stressed that practical exposure was key to embedding understanding: “Running mock cross-border transfer scenarios or time-sensitive case drills (case simulations) allows staff to practise communication workflows, decision-making, document handling, and coordination under pressure before real-life situations occur.”

Preparing teams for pressure in real-world cases

Beyond structural understanding, contributors also highlighted the need to prepare teams for the emotional intensity and operational pressure of real-world assistance cases.

Herrades said theoretical training alone was insufficient: “Effective preparation in international medical assistance requires far more than theoretical training. Teams must be equipped to operate under pressure, uncertainty, and high emotional exposure,” she said.

She emphasised the importance of simulation-based learning, including crisis scenarios such as intensive care unit (ICU) admissions abroad, medical evacuations, distressed families, and complex cross-border coordination. At the same time, she said, operational discipline is essential, as inconsistency in decision-making or communication could quickly create downstream issues.

In international environments, improvisation leads to costly mistakes

Alongside this, Herrades highlighted the importance of soft skills development, particularly in high-pressure environments where communication is as critical as clinical decision-making.

For Aspell, preparing teams for pressure is as much about confidence as technical knowledge. “Preparing people for high-pressure, complex cases requires building confidence, judgement, and the ability to operate under pressure,” she said.

She explained that scenario-based training helped bridge the gap between theory and practice, particularly when delivered in controlled but realistic environments. “By exposing teams to real-world case examples in a controlled environment, they can practise navigating complexity, managing communication across teams and making sound decisions when time is limited and the stakes are high,” she said.

Ho highlighted the operational balancing act faced by insurers and assistance providers in real cases. “Hospital staff should understand that insurers and medical assistance companies often need to balance clinical urgency, policy coverage, medical necessity, logistics, and patient safety simultaneously when managing a case,” he said.

He also stressed that early communication remained one of the most effective tools for reducing friction: “Early sharing of pre-arrival information between insurers, assistance providers, and hospitals is therefore essential to avoid confusion and delays.”

Schmiedhuber reinforced the importance of experiential learning in preparing staff for complexity. “Experience remains one of the best teachers in our industry, but organisations should not rely solely on learning on the job,” she said.

She highlighted the importance of exposure to real operational challenges, including multi-country coordination, language barriers, and evolving medical situations.

She also noted that cross-functional awareness remained a key differentiator in performance under pressure. “The more people understand the challenges faced by colleagues and partners, the better they perform when pressure increases.”

Conclusion

Looking ahead, Herrades argued that training frameworks must evolve alongside the realities of modern medical assistance. “As medical assistance operations become increasingly global and specialised, training must evolve from static and general models to continuous, specialised, and highly adaptive frameworks,” she said.

She identified growing regulatory complexity, differing data protection requirements, cost variation, and rising customer expectations as forces reshaping the sector. “Training can no longer rely solely on traditional manuals or one-time onboarding,” she added.

Organisations should make sure to provide their staff with access to continuous education and training to make sure they stay current and at the top of their game

To meet those demands, she advocated ongoing professional development supported by digital tools, regional expertise, and continuous learning systems. She also stressed that training should reflect the operational differences between regions. “A coordinator handling Latin America operates in a completely different environment than one managing Europe, the Middle East, or Asia,” she said.

In Herrades’ view, these changes have elevated training from an operational necessity to a core business function, describing it as “a strategic pillar – essential for risk management, operational excellence, and competitive differentiation”.

The need to broaden training beyond technical competence was echoed by Aspell, who argued that interpersonal skills were equally critical. “Technical accuracy alone is no longer enough – we must provide holistic, human-centred support,” she said.

Ho shifted the focus to collaboration across the wider medical assistance ecosystem, suggesting that greater consistency between organisations would improve both efficiency and patient care. “Hospitals can play an important role in establishing more consistent and transparent communication practices across the international medical assistance ecosystem,” he said.

He added that stronger alignment around shared processes would help minimise delays and misunderstandings: “Establishing mutually understood procedures for admissions, transfers, approvals, and discharge coordination can help reduce operational friction and improve continuity of care.”

Drawing these themes together, Schmiedhuber reflected on how the industry’s increasing complexity had transformed expectations around workforce development. “The industry today is far more complex than it was even 10 years ago,” she said, arguing that this changing landscape requires organisations to rethink how they approach professional development. “As a result, training can no longer be viewed as a one-time onboarding exercise,” she said.

For Schmiedhuber, maintaining expertise is now an ongoing responsibility for both employers and employees: “Learning never stops, so organisations should make sure to provide their staff with access to continuous education and training to make sure they stay current and at the top of their game,” she said.