While PBFB already provides claim support to corporate clients with millions of employees, the claim set is increasing the experience by providing quantitative scoring, including claim insights, approvals and scoring how claims are handled. Apart from this, employees, HR teams, insurance companies, and TPAS processes can also help them claim that employees, HR teams, insurance companies and TPAS processes are up to 50% faster when errors and more visibility.
Currently, we are focusing solely on streamlining GHI refund claims. This is a process traditionally borne by delays due to missing documents and lack of real-time updates. Using cutting-edge artificial intelligence (AI), natural language processing (NLP), and optical character recognition (OCR), claim sets provide faster and more transparency, from document submission to final claim approval.
“Refund claims continue to be one of the boring processes of group health insurance. The claim set is building a system that eliminates ambiguity and enhances real-time updates to users in the highest friction locations, GHI's refunds.” “This is more than automation. It's about providing clarity and trust in the most critical moments of the insurance experience.”
Rethinking GHI refunds for Indian companies
The claim is proudly built in India for Indian businesses, addressing the unique operational and infrastructure challenges of the country's corporate health insurance ecosystem. As India's first automated AILE LED claims engine in the field of B2B insurance, it marks a leap in digital innovation that aligns with its national vision for technology-driven transformation.
Today, many GHI reimbursement claims include multiple emails before and after a TPA or insurance company. The billing set changes this with AI-driven document checks, automatic verification, instant alerts and live tracking via WhatsApp, bringing even more speed and clarity to the process.
The platform uses AIRE LED classification to identify and extract information from documents such as invoices, prescriptions, and ejection summary. It can also flag inconsistencies against policy conditions, detect potential fraud, and significantly reduce the administrative burden of HR teams and insurance companies. Claims are sent via familiar channels such as mobile apps, emails, WhatsApp, and reduce real-time alerts for missing or invalid documents, and delays before they start.
Equipped with AI, OCR and NLP, billing setu:
- Automates reading documents from claim forms, pharmacy bills, hospital bills, prescriptions, discharge summary, and more.
- Missing or incorrect document flags in real time
- Provides claim insight approval to employees based on PolicyBazaar's vast historical billing data and constant updates at each step of the billing process.
- Intelligent Claim Routing: Assign claims to the right team based on document integrity, complexity, and assistance.
Safe, scalable and ready for the future
The billing set is built in strict compliance with data protection standards to ensure corporate-grade security. The platform is designed to seamlessly integrate with customer relationship management (CRM) systems, insurance company back-end systems, and HR tools.
The beta version currently supports GHI's refund workflow, but the modular architecture of ClaimSetu allows for future OPD claims and other categories to be extended to future engines of insurance operations across a range of product lines.
By eliminating manual work, reducing turnaround times and creating more empathetic claim experiences, the Claims Set is poised to set new benchmarks for the handling of corporate claims in India's rapidly changing workplaces.
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