NewgenONE Platform for
Expedite Claims Processing, from Rule-Based Computation to Fraud Prevention
Optimizing claims by maximizing straight-through processing and streamlining settlement across claim types to elevate customer satisfaction and retention.
“With Newgen’s Claims Management Solution, we achieved a 40% reduction in claims leakage through AI-driven fraud detection, improved TAT for non-early claims by 50%, and accelerated settlement time for living claims by up to 40%.”
VP, Insurance Claims
Learn what Newgen’s AI-powered Claims Automation Solution can do for you
Multichannel Initiation and Claims Handling
Allow customers to initiate claims from multiple channels, including self-service portal, website, and social media using convenient and user-friendly online platform. The solution is capable of handling claims against individual as well as group policies. The various types of claims include death claims, maturity, critical illness, permanent total disability (PTD), temporary total disability (TTD), and involuntary loss of employment.
Intelligent Claims Assessment
Automatically classify claims as “fast track” or “non-fast track” and identify admissible/non-admissible claims with built-in rules. The system can perform product-based calculation rules for reserve, death benefit, disability benefit, critical illness, and final payable, and generate a claim summary sheet. The solution has provisions for Investigation Portals and mobile apps. Leveraging AI/ML algorithms, the system performs comprehensive fraud checks on claims, mitigating risks and financial losses.
Operational Insight and Monitoring
Monitor and measure user efficiency with defined KPIs to address gaps. Ensure transparent and timely life insurance claims processing with escalation matrix and monitoring reports, and effectively track claims processing across departments.
Automated Claim Payout and Settlement
Reduce manual efforts and minimize errors with the help of rule-based payout determination. Claim amount is processed upon confirmation provided by the claimant.
Multichannel Initiation and Claims Handling
Allow customers to initiate claims from multiple channels, including self-service portal, website, and social media using convenient and user-friendly online platform. The solution is capable of handling claims against individual as well as group policies. The various types of claims include death claims, maturity, critical illness, permanent total disability (PTD), temporary total disability (TTD), and involuntary loss of employment.
Intelligent Claims Assessment
Automatically classify claims as “fast track” or “non-fast track” and identify admissible/non-admissible claims with built-in rules. The system can perform product-based calculation rules for reserve, death benefit, disability benefit, critical illness, and final payable, and generate a claim summary sheet. The solution has provisions for Investigation Portals and mobile apps. Leveraging AI/ML algorithms, the system performs comprehensive fraud checks on claims, mitigating risks and financial losses.
Operational Insight and Monitoring
Monitor and measure user efficiency with defined KPIs to address gaps. Ensure transparent and timely life insurance claims processing with escalation matrix and monitoring reports, and effectively track claims processing across departments.
Automated Claim Payout and Settlement
Reduce manual efforts and minimize errors with the help of rule-based payout determination. Claim amount is processed upon confirmation provided by the claimant.
Learn what Newgen’s AI-powered Claims Automation Solution can do for you
Multichannel Initiation and Claims Handling
Customers can initiate claims through multiple channels, including self-service portals, websites, and social media. Our user-friendly solution supports individual and group policies with claim types like death, maturity, critical illness, permanent total disability (PTD), temporary total disability (TTD), and involuntary loss of employment. For operations in Saudi Arabia, the platform integrates with critical national systems, such as Yakeen and Masdr, enhancing the accuracy of customer identification and compliance with local health insurance data standards.
Automated Assessment
Automatically classify claims as “fast track” or “non-fast track” and identify admissible/non-admissible claims with built-in rules. The system performs product-based calculations for reserve, death benefit, disability benefit, critical illness, and final payouts, generating a comprehensive claim summary sheet. Integration with the Council of Cooperative Health Insurance data also ensures automated eligibility checks, minimizing claim denial errors while meeting local regulatory requirements.
Fraud Detection and Reserve Management
Leveraging AI and machine learning to conduct robust fraud checks on claims can mitigate risks and prevent financial losses. The solution manages reserves based on claim complexity, ensuring adequate provisions for potential liabilities. Saudi-specific fraud detection is enhanced through integration with local databases, supporting accurate identity and claim validations in compliance with regulatory standards.
Automated Claim Payout and Settlement
Reduce manual efforts and minimize errors with the help of rule-based payout determination. Integration with local payment gateways like MADA, UR Pay, and STC Pay ensures seamless and compliant claim disbursements for customers in Saudi Arabia.
Multichannel Initiation and Claims Handling
Customers can initiate claims through multiple channels, including self-service portals, websites, and social media. Our user-friendly solution supports individual and group policies with claim types like death, maturity, critical illness, permanent total disability (PTD), temporary total disability (TTD), and involuntary loss of employment. For operations in Saudi Arabia, the platform integrates with critical national systems, such as Yakeen and Masdr, enhancing the accuracy of customer identification and compliance with local health insurance data standards.
Automated Assessment
Automatically classify claims as “fast track” or “non-fast track” and identify admissible/non-admissible claims with built-in rules. The system performs product-based calculations for reserve, death benefit, disability benefit, critical illness, and final payouts, generating a comprehensive claim summary sheet. Integration with the Council of Cooperative Health Insurance data also ensures automated eligibility checks, minimizing claim denial errors while meeting local regulatory requirements.
Fraud Detection and Reserve Management
Leveraging AI and machine learning to conduct robust fraud checks on claims can mitigate risks and prevent financial losses. The solution manages reserves based on claim complexity, ensuring adequate provisions for potential liabilities. Saudi-specific fraud detection is enhanced through integration with local databases, supporting accurate identity and claim validations in compliance with regulatory standards.
Automated Claim Payout and Settlement
Reduce manual efforts and minimize errors with the help of rule-based payout determination. Integration with local payment gateways like MADA, UR Pay, and STC Pay ensures seamless and compliant claim disbursements for customers in Saudi Arabia.
Features of Newgen’s AI-powered Claims Management Solution for Life Insurance
Multichannel Initiation and Customer Portal
Enable case initiation from multiple channels, including customer self-service portal, website, scanning solution, and social media. Customers can get real-time notifications and track the status of submitted claims over the portal. The solution allows the scanning of claims forms and KYC documents for claim initiation, and integration with the core system allows seamless fetching of policy details.
Intelligent Claim-level Processing
Auto-retrieve individual policy information by entering key indexing fields, reserve booking via core integration, and manage all claim types such as death, permanent total disability (PTD), temporary total disability (TTD), critical illness, and involuntary loss of employment claims. Claims duplicity can be prevented and flagged, and there are built-in rules to determine claim eligibility.
Client-level Notification
Generate a single notification number for claims filed against multiple policies and book claim reserves during the notification stage with the help of AI. Perform de-dupe check to rule out duplicate policy matches against the insured.
Operational Insight and Monitoring
Monitor and measure user efficiency with defined KPIs, ensure transparent and timely life insurance claims processing with escalation matrix and monitoring reports, and effectively track claims processing across departments.
Rule-based Algorithms
Leverage built-in rules to automatically classify claims as “fast track” or “non-fast track” and identify admissible/non-admissible claims. An authority matrix can be defined and used to allocate cases among different users. The system can also perform product-based calculation rules for reserve, death benefit, disability benefit, critical illness, and final payable. Claim eligibility rules for policy status, benefits/coverages, waiting/ survival period can also be defined.
Intelligent Claims Assessment
Perform a detailed assessment of each claim with an all-inclusive dashboard, undertake parallel processing for multiple referral activities, and request additional details based on dynamic needs. Generate claim summary sheet and route process based on assessor decisions. The system also supports intelligent data processing for claims triage and system-recommended decisions and the AI/ML algorithm can detect and prioritize fraudulent activity and assign a fraudulent score.
Smart Case Routing and Allocation
Automatically route cases based on the adjudicator’s workload and expertise and undertake effective registration, adjudication, tracking, and management of claim submissions using a single interface to track and manage claims. The flexible rule engine can automatically route claims to investigators based on workload and efficiency. The system also supports a transaction-based investigator portal for reports and data upload, enabling real-time communication between the on-field investigators and the system.
Multichannel Initiation and Customer Portal
Enable case initiation from multiple channels, including customer self-service portal, website, scanning solution, and social media. Customers can get real-time notifications and track the status of submitted claims over the portal. The solution allows the scanning of claims forms and KYC documents for claim initiation, and integration with the core system allows seamless fetching of policy details.
Intelligent Claim-level Processing
Auto-retrieve individual policy information by entering key indexing fields, reserve booking via core integration, and manage all claim types such as death, permanent total disability (PTD), temporary total disability (TTD), critical illness, and involuntary loss of employment claims. Claims duplicity can be prevented and flagged, and there are built-in rules to determine claim eligibility.
Client-level Notification
Generate a single notification number for claims filed against multiple policies and book claim reserves during the notification stage with the help of AI. Perform de-dupe check to rule out duplicate policy matches against the insured.
Operational Insight and Monitoring
Monitor and measure user efficiency with defined KPIs, ensure transparent and timely life insurance claims processing with escalation matrix and monitoring reports, and effectively track claims processing across departments.
Rule-based Algorithms
Leverage built-in rules to automatically classify claims as “fast track” or “non-fast track” and identify admissible/non-admissible claims. An authority matrix can be defined and used to allocate cases among different users. The system can also perform product-based calculation rules for reserve, death benefit, disability benefit, critical illness, and final payable. Claim eligibility rules for policy status, benefits/coverages, waiting/ survival period can also be defined.
Intelligent Claims Assessment
Perform a detailed assessment of each claim with an all-inclusive dashboard, undertake parallel processing for multiple referral activities, and request additional details based on dynamic needs. Generate claim summary sheet and route process based on assessor decisions. The system also supports intelligent data processing for claims triage and system-recommended decisions and the AI/ML algorithm can detect and prioritize fraudulent activity and assign a fraudulent score.
Smart Case Routing and Allocation
Automatically route cases based on the adjudicator’s workload and expertise and undertake effective registration, adjudication, tracking, and management of claim submissions using a single interface to track and manage claims. The flexible rule engine can automatically route claims to investigators based on workload and efficiency. The system also supports a transaction-based investigator portal for reports and data upload, enabling real-time communication between the on-field investigators and the system.
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