Case StudiesOptimized Health Insurance Claims Management and Reduced Claims Leakage for a Leading Health Insurer

July 26, 20210

The Challenge

The customer had legacy IT infrastructure with multiple system integrations. Lack of validations during claims processing led to claims leakage. Manual processing of claims consumed more time. The customer was heavily dependent on TPAs for claims processing. Customer was seeking a system which could give them more control over the TPA and enable transparency. The customer wanted to bring in-house part of the claims processing.

The Solution – Automated Claims Processing to Reduce Claims Leakage

iNube implemented a system with flexibility for both TPA and Insurance company to process claims.
End to End Health Claims Management Solution from enrolment of members to settlement of claims was implemented
Exhaustive product configuration module to enable customer to introduce product offerings
Custom built workflows to incorporate TPAs using own system to upload data at strategic points during claims processing via a front-end interface (TPA Portal)
Capability to map Provider SOC and tariff against unique Service Codes was done to enable digital validation of claims
Business Rule Engine to flag duplicate claims, insufficient BSI, package mismatch etc.
ICD 10 based configuration of benefits, covers to enable auto adjudication of claims

Value Delivered


Increase in auto adjudicated cases


TAT reduction in Claims Processing


Claims processed per month (Per day 50 claims)​


In network hospitals are currently empanelled in the system​

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