Eliminate inefficiencies in medical claims processing by coordinating how member benefits, claim rules, and provider fee schedules are configured and applied.

Health insurers in Asia face slow, error-prone claims operations and delayed go-to-market timelines, largely due to manual processes and IT dependencies. Assessors must review scattered sources – such as policy documents, provider contracts, tax rules, and co-pay terms – to accurately determine claim payouts, making the process difficult and time-consuming.
At the same time, configuring new benefits, rules, or tariffs for product launches often requires IT implementation, making business users reliant on technical teams and slowing down the rollout of new offerings.

Streamline health claims operations with
Core Claims

Eliminate inefficiencies in medical claims processing by coordinating how member benefits, claim rules, and provider fee schedules are configured and applied. Built for flexibility and speed, Core Claims empowers insurers to manage complex health benefits, claim guidelines, and provider fee arrangements through easy-to-configure modules – no IT dependency required.

Increase automated adjudication of health claims with preconfigured criteria, eliminating the need for manual cross-referencing and tedious calculations, while supporting both individual and corporate workflows through a single submission API.

See how it works

Why Core Claims?

Simplify the complexity of health claims administration with automated checks against policy benefit definitions, customised claims rules, and negotiated provider fees and discounts.

Accelerate health plan setup using ready-made templates and cloning tools in the benefits module. Empower business users to implement customised claim guidelines instantly via a no-code rule management interface – and say goodbye to IT ticket queues.

Improve adjudication precision by automatically matching claim lines against the right benefit and tariff definitions, and flagging unusual or suspicious submissions using AI models trained to detect outlier combinations of clinical diagnosis and procedure codes.

Automate claims adjudication with pre-configured benefits, rules, and fee schedules

Simplify the complexity of health claims administration with automated checks against policy benefit definitions, customised claims rules, and negotiated provider fees and discounts.

Faster setup with no-code configuration and smart templates

AI-powered accuracy at the line level

With Core Claims, you can:

Launch new insurance products faster with no-code configuration tools and templates that allow you to define benefits and rules rapidly – cutting down setup time from weeks to days.

Improve adjudication speed and staff efficiency by automating the application of complex policy terms, rules, and tariffs – eliminating the need for assessors to manually consult multiple systems or calculate payable amounts manually.

Ensure real-time tracking of claims and greater consistency in how policies are applied, thanks to a unified adjudication engine and a single submission API that integrates both individual and corporate claims processes.

Speed up go-to-market for new health plans

Launch new insurance products faster with no-code configuration tools and templates that allow you to define benefits and rules rapidly – cutting down setup time from weeks to days.

Enhance claims operations and reduce turnaround times