The Challenge
The customer was experiencing a growth phase and was looking to modernize and scale up their IT systems to cope with increased load. Above all iNube introduced several cutting-edge capabilities including workflow enabled claim processing based on financial limits, digitized provider management & Schedule of Charges (SOC), TAT configuration, Case management etc. to reduce claim processing times for health insurer.
Claims processing is a time-consuming, paper-intensive procedure that is also costly. Reducing processing time will increase customer satisfaction while decreasing expenses.
The Solution – Health Insurer Claims Management
Significantly, iNube decided to replace the current systems with a single comprehensive claim platform for health insurer. In addition, it leveraged its flagship platform – Especially CLAIMSLive Health, to meet the requirements of the Customer or Health insurer.
- In particular comprehensive end-to-end platform to handle complete claim adjudication process from intimation to settlement
- Rule engine with front end UI to enable business users to define rules for fraud detection
- 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 for investigation with integrated investigation mobile app in time
- Extensive reporting capability to help drive analytics
Value Delivered
- Indeed, it reduced manual activities with introduction of workflow enabled claims processing
- Replaced physical file processing, integrated with DMS and digitized most activities
- Helped identify deviations from standard line of treatment, medication, length of stay with case management
- Customer recognized for the ‘Best Claims Service Provider of the Year’ at Insurance India Summit & Awards 2018
