AI-Assisted Insurance Claim Processing

The problem ClaimGenie solves

Patient Problems

  • Getting hospitalized is a stressful event both for the patient and her loved ones
  • The process of availing Insurance is slow, full of hassles & stressful
  • Every minute they spend on Insurance is a minute they could have spent with the patient
  • Delays at the Pre-authorization stage could affect treatment initiation
  • Discharge days are more about securing paperwork and less about the next steps for the patient

Insurer Problems

  • Heavy Claims Processing Costs
  • Cost of Claims Processing stands at 10-15% of Total Operating Expenses
  • The TAT is not standardized even within the same Insurer, due to multiple claim processing entities(TPA)
  • Processing speed affects insurer rankings


National Health Stack(NHS) is trying to push for the digitization of health documents, which opens up the possibility to revolutionize claim processing.
Getting rid of the physical documents collection & manual claim processing method and replacing it with an automated rule engine can help us reduce the time required to process claims by order of magnitude.

Challenges we ran into

  • receiving patient data on Datapush URL did not work. We posted on slack and Devforum but it is still not rectified. We had to mock the data receiving flow
  • consent manager used to go down intermittently, causing temporary blockers on development
  • one of our teammate's health-id was blocked for 24 hours, due to which he was not able to grant consent for that period causing development blockers