Automated Claims Processes with Digital Health Claims Management Solution for a Health Insurer
The customer was experiencing a growth phase and wanted to scale up their systems. Their existing core system had limited functionalities. The current application lacked workflow for role wise claim processing based on financial limits. Provider management, SOC validation, TAT monitoring case management and investigation was being handled manually. In other words, there was an explicit need for an automated health insurance claims management system.
The Solution – Health Insurance Claims Management
iNube decided to leverage its existing product ClaimsLive Health, for Health Insurance Claims Management, to meet the requirements of the Customer.
End to End Claim adjudication process from intimation to settlement
Front end to configure business rules to enable automation of claims adjudication
Exhaustive Case Management module to configure medical protocols and drug & implant masters to identity any deviations from standard line of treatment
Suspect cases could be flagged assigned for further investigation either to an internal investigation or external agencies