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Indian Health Insurer Cuts Cashless TAT to 60 Minutes
An Indian health insurer moved claims, hospital, agent and document workflows into an integrated digital insurance ecosystem.
Client
Challenge
The stakes were operational and financial. Every delay in a cashless claim affects a patient waiting for a decision, while every unstructured document creates another point where information can be delayed, lost or manipulated.
The insurer also needed to manage hospital and agent operations consistently across a large network. Without structured digital workflows, verification, approvals, communication and compliance tracking depended too heavily on manual intervention.
The requirement was therefore broader than digitising documents. The insurer needed a connected operating model across provider management, agent enrolment, training, claims intake and document processing.
The insurer also needed to manage hospital and agent operations consistently across a large network. Without structured digital workflows, verification, approvals, communication and compliance tracking depended too heavily on manual intervention.
The requirement was therefore broader than digitising documents. The insurer needed a connected operating model across provider management, agent enrolment, training, claims intake and document processing.
Solution
The insurer introduced an integrated application landscape connecting PMS, AEMS, TMS, StarFax and DMS with core insurance systems and communication channels.
The Provider Management System digitised the hospital lifecycle, covering empanelment workflows, document and infrastructure verification, hospital grading, package definition and negotiation, communication and acceptance, geo-tagging, GIC onboarding and external integrations.
AEMS and TMS digitised agent self-service and assisted enrolment, configurable approvals, document management, PII masking, online acceptance, reminders, certification and compliance. TMS also connected course management, registration, sample examinations, IRDA exam automation, communication and certification.
StarFax created a multi-channel intake process for claims documents. Documents from email, fax and hospital portals could be digitised, matched automatically with hospitals and claims, routed through workflows and tracked through audit trails. DMS provided the structured document layer, including configurable rules, document locking and integration with the core insurance system.
The technology stack included Java and Spring, Alfresco DMS, Oracle 19c, EKS and Oracle Cloud. The important change was not the individual components; it was the way the insurer connected them into one operating landscape.
The Provider Management System digitised the hospital lifecycle, covering empanelment workflows, document and infrastructure verification, hospital grading, package definition and negotiation, communication and acceptance, geo-tagging, GIC onboarding and external integrations.
AEMS and TMS digitised agent self-service and assisted enrolment, configurable approvals, document management, PII masking, online acceptance, reminders, certification and compliance. TMS also connected course management, registration, sample examinations, IRDA exam automation, communication and certification.
StarFax created a multi-channel intake process for claims documents. Documents from email, fax and hospital portals could be digitised, matched automatically with hospitals and claims, routed through workflows and tracked through audit trails. DMS provided the structured document layer, including configurable rules, document locking and integration with the core insurance system.
The technology stack included Java and Spring, Alfresco DMS, Oracle 19c, EKS and Oracle Cloud. The important change was not the individual components; it was the way the insurer connected them into one operating landscape.
Impact
Cashless claims processing improved sharply. The insurer reported 82% of cashless claims completed within one hour and 99% within 120 minutes. Document automation reduced cashless claim turnaround time from three days to 60 minutes.
The document operation now handles approximately 9,000 emails and more than 30,000 manually scanned or uploaded documents each day. More than 135 million documents have been processed, with zero document loss reported.
The Provider Management System supports 16,441 network hospitals and increased hospital-empanelment availability to 100%. The insurer also reduced empanelment time and integrated with multiple TPAs.
Document automation delivered approximately 40% year-over-year savings in man-days. StarFax reduced storage requirements by 27% through avoidance of data duplication. Email success ratio improved from 30% to 90%, inbound-channel availability reached 100%, and workflow automation removed manual intervention from fax and email processing.
The insurer gained stronger visibility through digital workflows, security controls, audit trails, dashboards and productivity tracking across claims, hospitals, agents and internal operations.
The document operation now handles approximately 9,000 emails and more than 30,000 manually scanned or uploaded documents each day. More than 135 million documents have been processed, with zero document loss reported.
The Provider Management System supports 16,441 network hospitals and increased hospital-empanelment availability to 100%. The insurer also reduced empanelment time and integrated with multiple TPAs.
Document automation delivered approximately 40% year-over-year savings in man-days. StarFax reduced storage requirements by 27% through avoidance of data duplication. Email success ratio improved from 30% to 90%, inbound-channel availability reached 100%, and workflow automation removed manual intervention from fax and email processing.
The insurer gained stronger visibility through digital workflows, security controls, audit trails, dashboards and productivity tracking across claims, hospitals, agents and internal operations.
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