NewgenONE Platform for
Enhance Claims Management, from Instant Verification to Tailored Updates
Reimagining claims processing with AI-driven triage, centralized document management, and enhanced straight-through processing—delivering faster, more accurate payouts for an improved customer experience.
“With Newgen, we achieved 60% faster claims processing through AI-powered automation and an 85% reduction in claims leakage with robust fraud detection, driving compliance, financial savings, and improved customer satisfaction.”
Director of Claims, Major Health Insurance Provider
Learn what Newgen’s Digital Claims Automation Solution can do for you
Automated Claim Eligibility Validation
Conduct instant, automated verification of claim details by cross-referencing with policy data, network hospitals, and treatment details registered in the Council of Cooperative Health Insurance (CCHI) database. Reduce errors and prevent unnecessary claim denials while speeding up the verification process to meet local regulatory requirements.
AI-driven Claims Triage
Leverage AI to analyze claim data, categorize claims by complexity, and route them accordingly. Identify potential fraud, prioritize high-risk cases, and ensure only relevant claims reach manual review. Integrate with national data sources like Yakeen and Masdr for enhanced identity verification and accuracy in claims processing.
Auto-adjudication Engine
Automate claims adjudication by configuring custom rules to assess low-risk claims for instant approvals. Enhance process accuracy by employing AI models to assess compliance with local health insurance regulations and ensure alignment with policy terms approved by CCHI.
Unified Claims Workbench
Access a centralized platform consolidating all claims activities, from claim receipt to settlement. Empower claim adjudicators to review, analyze, and manage cases effectively using a single interface, with integrated support for payment processing through MADA, UR Pay, STC Pay, and SADAD for seamless claims settlements.
Automated Claim Eligibility Validation
Conduct instant, automated verification of claim details by cross-referencing with policy data, network hospitals, and treatment details registered in the Council of Cooperative Health Insurance (CCHI) database. Reduce errors and prevent unnecessary claim denials while speeding up the verification process to meet local regulatory requirements.
AI-driven Claims Triage
Leverage AI to analyze claim data, categorize claims by complexity, and route them accordingly. Identify potential fraud, prioritize high-risk cases, and ensure only relevant claims reach manual review. Integrate with national data sources like Yakeen and Masdr for enhanced identity verification and accuracy in claims processing.
Auto-adjudication Engine
Automate claims adjudication by configuring custom rules to assess low-risk claims for instant approvals. Enhance process accuracy by employing AI models to assess compliance with local health insurance regulations and ensure alignment with policy terms approved by CCHI.
Unified Claims Workbench
Access a centralized platform consolidating all claims activities, from claim receipt to settlement. Empower claim adjudicators to review, analyze, and manage cases effectively using a single interface, with integrated support for payment processing through MADA, UR Pay, STC Pay, and SADAD for seamless claims settlements.
Brands using Newgen Platform
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