Health Insurance Claims Management System Modernising claims processing and adjudication

The emergence of cashless hospitalization revolutionized the realm of claims management dramatically. The traditional claims management lifecycle was a simplistic, slow manual process that now called for a systematic, relatively automatic approach. This need for automation gave rise to the traditional legacy system. However, these systems fall short as the tide of digitization and data balloon. And, call for a rapid transformation of Legacy Claims Management Systems

The shortcomings of carriers saddled with legacy software are towering at an exponential rate as data pools expand every passing second and more variables come into the equation.

Major Challenges Faced by Insurers Employing Legacy System

The reactive system limits the scope for healthier portfolios based on preferred risk, thereby, dampening efficiency across all business functions.

Timely disbursement of claims as outlined in the benefits contract.

Protection from fraudulent claims and abuse.

Accurate transaction management.

On top of these challenges, Mediclaim frauds are getting increasingly sophisticated, to the point where legacy software completely fails to flag it.

Commonly committed health insurance frauds can come in the guise of –

Concealing pre-existing disease (PED) / chronic ailment

Siphoning off premium by providing fake policy to customers

Fabricated documents to meet policy terms conditions

Duplicate and inflated bills


Staged accidents and fake disability claims

Reap The Benefits of Eicore’s Claims Management Software for Health Insurance

Boost Efficiency Across Operational Hierarchy

Reduce human interventions dramatically to eliminate the risks posed by human error. The robust claims management solution ensures the complete assessment of patient benefits and authorization prerequisites in real-time without compromising on accuracy.

Streamline Claims Management

Increase the efficiency of the claim cycle by automating and streamlining electronic billing, payment, and document submission, claim rejections, and resubmissions. Get a birds-eye view into the entire process with organized dashboards for easy disbursement.

Efficient Product Configuration

Configure products with dynamic terms and conditions conveniently with just a few clicks. Advanced technology aids in defining risk appetite accurately for efficient policy generation and tailoring of pre-underwritten products.

Convenient Access

Advanced technology empowers agents and brokers to check claim status 24*7, thereby boosting overall transparency levels. Enhance customer satisfaction in line with business requirements any time of the day.

Customer Support

Enhance customer satisfaction and retention rate with dependable support 24*7 with our state-of-the-art technology. Cut down operational costs by relieving your business from incompetent representatives.

Eicore offers comprehensive software services and products for brokers, insurers, HMOs, insurance TPAs, self-funded schemes and retail users. Eicore’s health insurance claims management software is an end-to-end and client-focused software providing solutions for claims handling, delivering significant benefits to insurance organizations with its wide-ranging functionalities. The claims management software integrates seamlessly with the existing policy administration system and external entities, thus digitalizing the claim process and saving resources, operational cost, and time, increasing efficiency, and preventing fraud.