Digital Platform for Automated Health Insurance Policy and Claims Management

The client faces inefficiencies in managing employee health insurance policies and claims, with manual processes leading to long handling times, increased operational costs, and suboptimal customer experience. Additionally, the client aims to strengthen its brand image as a modern, customer-centric insurer by adopting innovative digital solutions.

A large insurance provider seeking to modernize its health insurance services through digital automation, targeting both corporate clients and individual policyholders.

• Implement an online platform enabling employers to efficiently manage employee health insurance policies through CRUD functionalities, allowing quick creation, updates, and cancellations.
• Provide policyholders with online access to submit claims, upload medical documentation, and track reimbursement statuses, reducing reliance on direct contact and manual processing.
• Automate the processing of invoices and medical documentation through integration with external medical billing systems to improve accuracy and speed.
• Reduce overall operational costs by automating workflows and minimizing manual intervention.
• Enhance customer satisfaction by delivering faster service and positioning the client as a leading innovative insurer.

• CRUD functionalities for employer-managed employee insurance policies, enabling creation, read, update, and cancellation.
• Online claims submission interface allowing employees to report hospitalisations, upload medical documentation, and monitor reimbursement status.
• Integration with external medical billing systems for automatic invoice processing and validation of medical documentation.
• User authentication and role-based access control for employers, employees, medical providers, and administrators.
• Real-time notifications and status updates for claims and policy changes.
• Dashboard and reporting tools for transparency and operational insights.

• Medical billing systems for invoice processing
• Identity verification and authentication providers
• Notification platforms for alerts and updates

• Scalability to support growth in user base and transaction volume
• High availability with 99.9% uptime
• Data security and privacy compliant with relevant regulations
• Performance metrics supporting fast response times under load

The implementation of an automated, user-centric health insurance management platform is expected to significantly reduce processing times and operational costs by automating workflows. It will enhance service speed, improving customer satisfaction and loyalty. The project aims to achieve measurable efficiency gains, including faster policy management and claims handling, while strengthening the brand image as a forward-thinking insurance provider.