Health Insurance Claims Management Software

Health Insurance Claims Management Software

Digitizing Every Step of Health Claims Management

ClaimsLive Health is a state-of-the-art health insurance claims management software, for Insurance Companies and Third Party Administrators (TPAs). It provides end-to-end claims management, enables fraud detection and reduces claims leakage.


ClaimsLive Health enables effective control and management of health insurance claims – right from enrolment to settlement.

Core Building Blocks – A Modular Approach

ClaimsLive Health has flexible core modules. They can be leveraged independently to address specific business requirements.

  • Benefit Administration

    Configuration of health insurance products including benefits, covers, limits, co-pay, deductibles, exclusions etc. Configuration of benefits in ICD 10 terms
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  • Provider Management

    Management of network providers grading, standardized schedule of charges
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  • Corporate Portal

    Front end interface for individual members, HR administrators to enable respective functionalities
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  • Business Rule Engine

    Configuration of business rules to enable automation of claim processing and identification of fraudulent/suspect claims
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  • Suspect Case Management

    Identify and investigate suspect claims using configured business rules
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  • TPA Management

    End-to-end empanelment of third party administrators (TPAs)
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  • User Management

    Manages users across the applications

  • Master Data Management

    Managing and configuring master values

  • Enrolment Management

    Capture member details for group policies

  • Dispatch management

    Manage logistics of printing and distributing health cards

  • Claims Management

    Workflow driven claims processing from Pre-Auth to Settlement

  • Payment & Settlement

    Calculation of net liability and generation of settlement reports

  • Grievance Management

    Capture and track status of complaints

  • Case Management

    Enable configuration of medical and/or surgical protocols, claim costs and identify outliers

  • Mobility Extensions

    Native mobile apps for on-field activities including health claims investigations, hospital audit etc.

  • Float Management

    Maintain float for payment of claims by TPAs

  • Communication Management

    Configurable notifications to all stakeholders, on defined trigger events

Value Proposition

As a comprehensive health insurance claims management software, ClaimsLive Health, comes with a host of benefits, designed to meet your business objectives.

  • Reduce Turnaround Time (TAT)

    Digitization of benefits, product rules, covers and provider tariffs helps to reduce TAT

  • Streamline Claims Processing

    Benefits mapped to ICD 10 codes make processing of claims efficient by automatically classifying permissible and exempt claims

  • Enhance Operational Efficiency

    Digitize voluminous SOC, tariff data of each provider to make data processing easier, enabling faster claim settlement

  • Automate Processes

    Automatically route claims to specific roles with defined privileges

  • Highly Configurable Business Rules

    Empower your business users to configure business rules to suit your organization

  • Supports Retail, Group, and Social Sector scheme

    Seamlessly handle individual retail claims or scale up to handle large volumes of claims under social sector schemes

  • Issue1 Real Time Quotes/Policies

    Instantly generate quotes and issue policies. Reduce load on your core insurance system

  • Provide Quick Turn Around Time (TAT)

    Delight your customers by providing quicker turnaround times for policy issuance, renewals, endorsements

  • Ensure Greater Flexibility

    Allows insurance companies to configure different privileges for pricing, underwriting and operations to
    different intermediaries

  • Gain Better Oversight

    Take complete control over your distribution network with configurable levels of pricing and underwriting

  • Increase Transparency

    Manage complex commission structures and make payments online

  • Be Eco-friendly

    Help the environment by enabling end-to-end paperless process for policy issuance

Interested to learn more about
ClaimsLive Health?

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