i3claim

Transforming Medical Claims Processing

10,000+ manual hours saved | Avg. INR 4K/claim saved due to payment leakages

Overview

i3systems’ automation claims solution helped one of the leading insurance providers in India to optimize claims processing, reduce operational cost, and in delivering a smooth customer experience. Our solution helped in bringing down up to 80% of the operation cost and reducing the turnaround time to approx. 30min in over 90% of the cases.

Client Detail

One of the largest Indian private general insurance company catering for the demands of individuals, corporates, and SMEs. The client has a large market share across various insurance products across the domains of health, auto, travel and home.

Business Context/Challenge

Healthcare industry is constantly evolving and with that, the customer's preferences have also changed. They are looking for insurers who can process and approve medical claims efficiently. 


Requirement:

To meet the demand of the industry, the insurer wanted to - 

  • Optimize claim costs
  • Increase efficiency of the claims processes 
  • Improve turnaround time and customer experience
  • Meet the increase in the volume of cases in the future with a scalable solution
  • The insurer's current system handles over 1.45L health claims annually
  • The total processing cost is approx. INR 1.10 crore

Our Solution

i3claim is a flagship product of i3systems enabled with intelligent automation that provides end-to-end handling of the claim backend process. The solution is equipped with components to manage the overall claims process from accurate data ingestion, quality checks, cognitive decision models, fraud detection, settlement creation, to authorization and approval processes. This helps in reducing manual intervention and operational costs significantly. 


Furthermore, our solutions also prevent payment leakages leading to savings of 5-10% per claim for payment leakages alone. i3claim delivers the agility needed to enhance customer satisfaction as well as helps to keep up with the rapidly evolving regulatory changes.

Benefits

Our i3Claim solution delivered improved efficiency and accuracy as well as reduced claim handling & queuing time by 60% and 75% respectively, thereby helping the insurer with annual savings of over INR 31,90,000. Furthermore, the solution helped in bringing down up to 80% of operation cost as well as reduce the claim processing time from 3-4 hours to 30 mins.

Key Benefits:

  1. Enhanced customer satisfaction 
  2. Reduced operational costs
  3. Reduced claim leakages (errors in the decision, fraud, etc.)
  4. New Customer acquisition through differentiated value proposition
  5. Real-time data analytics for business intelligence & executive reporting 
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