Solutions / Sector systems
Insurance claims claims management system
Claims are where an insurer keeps or loses a customer. We build claims systems that take intimation from any channel, route each claim to the right handler or surveyor, track IRDAI turnaround timelines and give the policyholder clear status updates.
Modules
Modules we build into your Insurance claims
Start with the modules that matter most and add the rest in later releases.
- Claim intimation
- Intimation by app, web, call centre, WhatsApp or broker, with policy validation and a claim number on the spot.
- Documents and evidence
- Upload of bills, FIRs, photos, discharge summaries and KYC, with checklists by claim type.
- Survey and investigation
- Surveyor assignment, inspection reports, photo and video evidence, and field investigation for suspicious cases.
- Assessment and approval
- Coverage checks, deductibles, sub-limits and authority matrices, with every decision recorded.
- Cashless and pre-auth
- Hospital pre-authorisation and network garage approvals, tracked against IRDAI timelines.
- Settlement and payment
- Settlement calculation, discharge vouchers, payment to bank account and recovery or salvage records.
- Grievances and reports
- Complaint handling linked to the claim, and reports for management and regulatory returns.
AI built in
Where AI saves time in this system
Document extraction
Reads hospital bills, discharge summaries and repair estimates, and fills the claim fields for a handler to confirm.
Fraud signals
Flags patterns such as repeat claimants, late intimation, edited images or linked parties, for a person to investigate.
Damage photo triage
Sorts motor claims photos by part and severity to help the surveyor plan, while the surveyor makes the assessment.
Status updates
Explains to the policyholder, in their language, what is pending on their claim and what they need to send.
- Open claims
- 2,316
- Avg settlement time
- 11 days
- Within IRDAI TAT
- 94%
- Flagged for review
- 4.1%
Claims settled per week
Open claims by stage
- Documents pending31
- Survey24
- Assessment22
- Approval13
- Payment10
Effort and cost
USD 1,800 to 3,200
INR 1,79,100 to 3,18,400, plus taxes, for a typical first release
- Effort
- 900 to 1,600 hours
- Timeline
- First release in 7 to 10 weeks
At the 2good.dev rate of USD 2 or INR 199 per hour, billed against outputs you accept. Your own estimate depends on modules, integrations and data migration.
Build, buy or both
Large insurers often run claims inside a licensed core insurance suite, and replacing that rarely makes sense. Custom or hybrid pays off around it: a claims front end for customers and partners, a surveyor app, document AI, or a fraud workbench. Brokers, TPAs and insurtechs with a narrow product line often get better value from a focused custom claims system than from a full suite they only partly use.
Connects with
- Policy administration system
- TPA platforms
- National Health Claims Exchange (NHCX)
- Hospital and garage networks
- Payment gateways and banks
- Core accounting
- WhatsApp Business
Industries
Sectors that use Insurance claims this way
Questions
Insurance claims: common questions
Does it track IRDAI timelines?
Yes. Each claim type carries its regulatory and internal turnaround clocks, with alerts before a deadline is missed.
Will AI reject claims automatically?
No. AI extracts data and raises flags. Decisions to approve, reduce or repudiate stay with authorised people and are recorded.
Can it connect to NHCX?
We design health claims flows to exchange data through NHCX where you are onboarded, alongside existing TPA and hospital channels.
Talk to us
Planning your Insurance claims?
Tell us what you use today and what is not working. We will say whether to extend it or build.
Start a conversation
Tell us what you are trying to build.
Share the problem in a short call. You leave with a clear view of the approach, the team and the cost.
A specialist replies within one working day. The first conversation is free.