Speeds claims review to minutes

IndusInd General Insurance said on May 16 that it is using artificial intelligence to speed up claims intake, document review and policy matching, in a push that mirrors wider changes in India’s health-insurance market. The insurer said tasks such as reviewing health-insurance claim documents and matching policy terms, which once took days, can now be completed in minutes. The company said AI is also being used to extract data from emails, forms, calls and images and to flag suspicious claims earlier in the process. May 9 offered a public-sector version of the same pitch. At an Auto-Adjudication Hackathon Showcase in Bengaluru, India’s National Health Authority, or NHA, said AI and machine-learning tools were being developed to speed claims adjudication under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, or AB PM-JAY, while reducing fraud and manual intervention. NHA Chief Executive Officer Sunil Kumar Barnwal said the authority’s in-house auto-adjudication work had reduced average claim processing time from nearly 20 days to around four hours. (thehindu.com) ### Where in the claims chain is AI saving time? IndusInd General Insurance said the time savings begin at first notice of loss, when a customer reports a claim. The insurer said AI can convert information from emails, forms, calls and images into structured data within seconds, cutting manual effort and improving data consistency by extracting as much as 90% to 95% of data quickly. (thehindu.com) The same May 16 article said automation then moves into routing and review. IndusInd said AI classifies claims by complexity, urgency and value, allowing 70% to 90% of simple claims to move through a more direct process while more complex cases are sent to claims specialists. It said automated tools can then verify policy details, check coverage and assess claim validity against large volumes of data. (thehindu.com) ### What does “minutes instead of days” actually cover? IndusInd General Insurance tied that claim to document-heavy steps. The insurer said reviewing health-insurance claim documents and matching policy terms, work that previously took days, can now be completed in minutes with AI-assisted systems. It said those systems reduce processing time and improve accuracy by limiting human error. (thehindu.com) Star Health and Allied Insurance Company described a similar shift in March. Whole-time Director Himanshu Walia said about 20% of the company’s claims were already being settled through AI and that the insurer expects that share to rise to as much as 50% within two years. Star Health said it handles more than 5,800 claims a day and processes 96% of cashless claims within three hours. (thehindu.com) ### How is fraud screening moving earlier in the process? IndusInd General Insurance said AI is being used to identify unusual patterns and inconsistencies early, allowing suspicious claims to be flagged before they move deeper into the workflow. The insurer said that approach lets investigators act proactively while avoiding delays for genuine claims. (thehindu.com) March 6 brought a regulatory deadline behind that shift. Moneycontrol reported that India’s Insurance Regulatory and Development Authority, or IRDAI, required insurers, reinsurers and distributors to adopt a fraud risk management framework from April 1, 2026, including continuous monitoring, board-approved anti-fraud policies and participation in a shared repository run by the Insurance Information Bureau. (thehindu.com) ### What are public systems testing now? The NHA’s May 9 and May 10 events in Bengaluru showed the kinds of tools now being tested for government-backed claims processing. The agency said teams demonstrated systems that can read low-quality scanned records with multilingual optical character recognition, extract billing and clinical data, check compliance with treatment guidelines, correlate radiology images with reports, and detect forged documents, fabricated reports and ghost identities. (moneycontrol.com) The NHA said the hackathon received about 3,500 registrations and that selected solutions could be considered for future deployment within the AB PM-JAY ecosystem, which processes nearly 50,000 claims daily across more than 1,900 treatment packages. Winning teams received cash prizes of 500,000 rupees, 300,000 rupees and 200,000 rupees. (thehindu.com) ### What is forcing insurers to automate now? April 7 research from Milliman pointed to the operational pressure behind these projects. The consulting firm said IRDAI’s rules, effective August 1, 2024, require cashless pre-authorization decisions within one hour and final authorization within three hours after a hospital’s discharge authorization request, compressing review windows and limiting reliance on manual scrutiny. (thehindu.com) The next test is deployment at scale. IRDAI’s fraud framework has been in force since April 1, 2026, and the NHA said in May that selected hackathon solutions could move into the AB PM-JAY system, where they would be used on a claims base of about 50,000 a day. (moneycontrol.com) (milliman.com)