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Business Rule Engine for Leading Health Insurance TPA

The Challenge

In general, the client of a leading third-party administrator (TPA), formed by the joint venture of major public sector general insurance providers in India. Above all they are looking forward a set of functionalities to handle the control and manage the health insurance claims even more effectively with the technology tools such as business rule engine operations.

• An advanced technology suite in health insurance claims processing
• Alignment of the solution with its corporate vision
• Adopt industry best practices
• Bring in greater efficiency in its core processes
• Enrich customer experience

The Solution

iNube implemented an exclusive insurance broker technology to meet the requirements of the customer.

  • Adopted a greenfield development approach of building a new health insurance solution from the ground-up
  • Simplified the business processes in a multi-PSU driven health insurance set up
  • Digitized provider rates for enhanced service
  • Set up business rule engine to even more efficiently tackle the complexity of data
  • Sophisticated benefits administration will present as a result

Value Delivered

Lastly, iNube developed an enhanced insurance broker platform significantly to meet the need of the customer.

  • Automation of claims handling process with an innovative healthcare claims management software
  • Standardized data exchange
  • Detected & prevented fraud leakages through an intelligent Business Rule Engine
  • The healthcare insurance claim management software ensured quick Turnaround Time (TAT) to consequently acknowledge claim submission & settlement by the time
  • Reduced grievances from customers and providers at the present time
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