Claim Management Module

End-to-end claim lifecycle for insurance brokers. Multi-insurer tracking. IRDAI TAT compliance. Document workflow. AI claim triage and fraud scoring. Built for the brokers who measure customer experience by how fast claims close.

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20+
Insurer Workflows
Auto
IRDAI TAT Tracking
AI
Triage & Fraud Scoring
B2C
Self-Service Intimation

Claims are where customer trust is won or lost

A customer with a smooth claim experience becomes a repeat buyer for life. A customer with a stuck claim becomes a one-star review and a competitor's referral. Yet most brokerages run claim management on spreadsheets, WhatsApp groups, and prayer — losing visibility, missing IRDAI TATs, and exposing themselves to regulatory risk.

InsureFlow's Claim Management module turns claims from your weakest workflow into your strongest customer-retention engine. Every claim is tracked, timed, escalated, and closed with a complete audit trail — across every insurer you work with.

End-to-End Claim Lifecycle

From the moment a customer intimates a claim to the moment the settlement amount hits their bank account — every stage is tracked, time-stamped, and visible to the right people.

  • Claim intimation (customer self-service, agent-assisted, or back-office)
  • Document collection with insurer-specific checklists
  • Surveyor appointment and survey report tracking
  • Estimate evaluation and approval workflow
  • Settlement processing with payment confirmation
  • Customer feedback collection (auto-trigger on claim closure)
📋 CLAIM CLM/2026/4729
Rajesh Patel · Family Floater · Apollo Hospital
Claim amount: ₹1,24,500 · Insurer: Star Health
✓ Intimated · Day 0
22-Mar 09:14
✓ Documents Collected · Day 1
23-Mar 14:02
⏳ Insurer Review · Day 3
In progress · IRDAI TAT: 27 days remaining
○ Settlement

IRDAI TAT Compliance — Built In

IRDAI mandates specific turnaround times for every claim milestone. Missing them invites regulatory scrutiny. InsureFlow tracks each TAT in real time with countdown timers and automatic escalation.

  • Acknowledgement TAT — 3 days from intimation
  • Surveyor appointment TAT — 3 days for motor, 7 days for property
  • Survey report TAT — 15 days (claim ≤ ₹1 Lakh), 30 days (above)
  • Final settlement TAT — 30 days from final survey report
  • Auto-escalate to senior handler when TAT countdown drops below 48 hours
  • Compliance reports ready for IRDAI inspection
⚠️ TAT BREACH ALERTS · TODAY
CLM/2026/3892 · Acknowledgement TAT
⏰ 6 hours remaining · Reliance General · Auto-escalating to Mr. Shah
CLM/2026/3870 · Survey Report TAT
⏰ 32 hours remaining · ICICI Lombard · Follow-up sent
CLM/2026/3801 · Settlement TAT
⏰ 5 days remaining · Bajaj Allianz · On track

AI Claim Triage & Fraud Scoring

When a claim is intimated, the AI evaluates it against policy details, claim history, document patterns, and known fraud signals — then routes to the right handler with the right priority.

  • Auto-classifies: fast-track cashless, standard, high-value, fraud-review
  • Surfaces fraud red flags: clustered claims, document anomalies, policy-just-issued patterns
  • Recommends documentation needed for fastest closure
  • Predicts probable settlement amount based on comparable historical claims
  • Learns from your team's actual decisions and improves over time
Business Impact: 30–40% faster claim closure on standard cases. 3–5× more fraud caught vs manual review.
🤖 AI TRIAGE · CLM/2026/4729
Priority ScoreFAST-TRACK
Low fraud risk · Cashless network hospital · Policy active 14 months · Patient history matches diagnosis
Recommended Documents
✓ Pre-auth form · ✓ Hospital final bill · ✓ Discharge summary · ✓ Investigation reports · ✓ Doctor's prescription
Predicted Settlement
₹1,08,000 – ₹1,18,000 (based on 47 comparable claims)
Customers file claims in 3 minutes from their phone

B2C mobile app and customer portal let policyholders intimate claims, upload documents, and track progress without calling your office.

📱
In-App Intimation
Customer taps "File Claim" in mobile app. Selects policy. Adds incident details. Uploads photos.
📄
Doc Upload
AI scans uploaded docs. Validates completeness. Flags missing items with one-tap follow-up.
🔔
Live Status
Customer sees real-time status. WhatsApp updates on every milestone.
Feedback Loop
Auto-NPS survey on claim closure. Negative feedback escalates instantly.
Claim management questions
How does InsureFlow track multi-insurer claims?
Each insurer has different claim formats, TAT requirements, and document checklists. InsureFlow normalises all of this into a single dashboard. Each claim shows insurer, current stage, days elapsed, IRDAI TAT countdown, and next action — across all 20+ integrated insurers.
What is IRDAI TAT compliance?
IRDAI mandates specific turnaround times for claim acknowledgement (3 days), surveyor appointment (3 days), survey report (15–30 days depending on claim), and final settlement (30 days from final survey). InsureFlow tracks each milestone with auto-alerts and audit logs.
How does AI claim triage work?
When a new claim is logged, the AI evaluates the policy details, claim amount, claim type, and customer history to assign a priority score and route to the right handler — fast-track for low-amount cashless health claims, senior handler for high-value motor claims, fraud-review for anomaly patterns.
Can customers file claims directly?
Yes. The customer mobile app and customer portal allow self-service claim intimation with document upload. The agent and back-office team are notified instantly and take over the workflow from there.