Policybazaar unveils ClaimSetu, an AI-based engine designed to streamline and accelerate Group Health Insurance reimbursement claims with advanced automation.
Policybazaar for Business (PBFB) has introduced ClaimSetu, an AI-based health claims engine that is specialised to ease and optimise Group Health Insurance (GHI) reimbursements. Integration of technologies, such as Artificial Intelligence (AI), Optical Character Recognition (OCR), and Natural Language Processing (NLP), brings the real-time delivery of insights, scores, and alerts to stakeholders, including employees and HR, TPAs, and insurers, and remakes the historically befuddling reimbursement experience into an opaque and time-consuming process.
ClaimSetu: Bringing AI to the Heart of Insurance Processing
ClaimSetu employs AI to show checks on validating documents and healthcare claims in real time. Whether it is hospital bills or prescriptions, it will report on any missing or mismatched documents to prevent the back-and-forth communication. Employees are continuously informed of the status and the likelihood of approving the claim due to real-time monitoring (even on WhatsApp). Who says what on its scoring engine, which bases its projections on the company-stored historical data, is a tool that enables policyholders to gain some predictability and clarity about a previously opaque process by estimating the probability of the claim getting approved.
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Engineered for Indian Workplaces and Future Expansion
ClaimSetu is proudly manufactured in India, with roots in common Indian business issues like infrastructure and workflow pain points. It helps both the HR departments, the insurance providers, and the workers since it also eliminates delays, bureaucratic tedium, and misinformation. The modular nature will guarantee its future scalability in the ability to scale more into OPD claims and other insurance product lines, thus providing a long-term investment opportunity in enterprise insurance technology.
Security, Speed, and Smarter Claims Are Now the Standard
ClaimSetu does not merely automate it but also intelligently routes claims on the basis of document completeness and complexity reduction, enhancing at the same time the highest possible level of data security. The platform is constructed to merge with CRM and insurer backends in order to have assurance of compliance as well as flexibility. Above all, it eradicates the anxiety associated with the paperwork and generates credibility in critical health instances.
With Indian workplaces going progressively more digitized, solutions such as ClaimSetu will be a marker of a new future in which technology and compassion can coexist in healthcare.
