Process automation for Re-Engineer Health Claims

According to a government report Health insurance witnessed 13.3% growth in GDP in FY21. An increase in the limit of Foreign Direct Investment (FDI) to 74% in Indian insurance companies has been seen. This is expected to bring in more capital into the sector, aiding greater insurance penetration in India with the help of insurance process automation.

While the growing awareness on the benefits of health insurance has boosted GWP for health insurance providers, it has also resulted in more claim inflow as compared to the past. Certainly, to counter this growth and to process them under the committed duration, insurers have had to increase the team effort and size or partner with TPA Claim Processing Teams to adjudicate the claim process automation more efficiently.

SOC (Schedule of Charges) from the empaneled hospital has been one of the key factor to determine the quantum of the amount to be paid during claim processing. Maintaining the details of SOC manually, in the claim application makes it a tiresome task – to refer the details while verifying it against the bill’s details provided by the service provider. Most often this leads to –

  • Human error resulting in financial impact.
  • Higher time spent to download the SOC document file and to search the medical services applicable with service charge details. Further to compare the SOC with bills received from the claimant.

Process automations in insurance help by freeing up employees from time-consuming manual tasks, drive efficiency and speed up processes. Digitizing the Schedule-of-charge and automating the verification process is an important step towards reducing the time to process claims.

This case study explores the SOC automation and verification feature of our CLAIMSLive Health Platform.



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