Healthcare Benefits Administration

Eliminate Fraudulent Claims with Red Flag Alerts for Suspect Claims

Suspect Case Management Module can help identify and investigate suspect claims using configured business rules


ClaimsLive Health, our state-of-the-art and customizable technology platform for end-to-end digital claims management and fraud detection for health insurance offers an exclusive ‘Suspect Case Management Module’ that helps to identify suspicious/suspect claims and providers by analyzing data using our sophisticated ‘Business Rule Engine’.


Robust functionalities of the Suspect Case Management Module helps achieve operational excellence and combats insurance claims fraud

Configure scenarios based on which suspect cases are auto flagged

Auto assign suspect cases for investigation

Push the assigned suspect cases to mobile device for conducting investigation

Capture investigation details along with audio visual evidence on mobile device

Submit investigation report on a real-time basis from mobile device

Tag investigation report to claim

Flag the entities and add to the watch list

Value Proposition

Leverage the various benefits of Suspect Case Management Module and ensure seamless claims processing

  • Reduce Claims Leakage

    Reduce claims leakage by intelligently identifying illicit claims

  • Maximize Efficiencies

    Maximize efficiencies by proactively addressing suspicious cases

  • Ensure Quick Claims Processing

    Ensure quick claims processing through streamlined case management

  • Identify and Investigate Suspicious Claims

    Eliminate claim fraud with superior fraud detection capabilities

  • 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 eliminate claims fraud by
identifying suspect cases of claims?

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