Transforming Claims Processing for a Mumbai-Based Insurance Provider

The Challenge

Our client, a health insurance provider serving 2M+ policyholders, was processing claims through a combination of spreadsheets, email workflows, and a legacy system from 2008.

The results were predictable: claims took an average of 15 days to process, error rates ran at 12%, and the compliance team spent more time firefighting audit findings than improving processes. Staff morale was low, and policyholders were frustrated.

Our Approach

We began with a 3-week discovery phase to map every step of the claims lifecycle — from initial submission to final settlement. What we found was a system held together by institutional knowledge, manual workarounds, and extraordinary individual effort.

Our approach was to rebuild the core workflows digitally, without disrupting the institutional knowledge that made the existing system function at all. This meant working closely with the claims team throughout the design and build phases.

The Solution

We designed and built a claims management platform with four core modules:

1. Intake & Triage — Automated document parsing and routing based on claim type, value, and complexity
2. Clinical Review — Structured review workflows with decision support and rule-based pre-authorisation
3. Compliance Checks — Automated regulatory validation against IRDAI guidelines and internal policy
4. Settlement & Reporting — Real-time dashboards, audit trails, and automated settlement processing

The platform was built on React (frontend), Node.js microservices (backend), and PostgreSQL with row-level security. AWS Lambda handled document processing at scale, and FHIR API integrations enabled connectivity with hospital systems.

Implementation

We delivered in three phases over 9 months:

• Phase 1 (Months 1–3): Core intake and routing; parallel run with legacy system
• Phase 2 (Months 4–6): Clinical review workflows; compliance module
• Phase 3 (Months 7–9): Settlement automation; full cutover; training

The parallel run in Phase 1 was critical — it gave the team confidence in the new system before the cutover and surfaced edge cases that would have been missed in testing alone.

Results

• Claims processing time: 15 days → 4 days (73% reduction)
• Error rate: 12% → 1.8% (85% reduction)
• Regulatory compliance: 100% audit pass rate in first year
• Staff productivity: 2.5x improvement
• Policyholder satisfaction: NPS improved by 34 points in 6 months post-launch

Technologies Used

React frontend, Node.js microservices, PostgreSQL with row-level security, AWS Lambda for document processing, FHIR API integrations for hospital system connectivity.