Claims, underwriting and policyholder service, prepared by AI and decided by your people
We build document, vision, voice and AI-security systems for insurers, TPAs, brokers and insurtechs. Every extracted field, flag and call outcome links back to its evidence, so assessors, underwriters and compliance teams can check it.
Insurance runs on documents and conversations: claim files, pre-authorisation requests, broker submissions, policy wordings, renewal calls and claim-status queries. That is where applied AI helps today. It can read a messy claim file and hand an assessor clean, source-linked fields, flag a pharmacy bill that looks edited, triage motor damage from photos, take routine renewal and status calls in Hindi or Tamil, and test a sales bot for mis-selling before customers meet it. It should not decide claims, set prices, judge medical necessity or label a customer a fraudster. Those calls stay with medical officers, licensed surveyors, underwriters and investigators. We design every system so that people decide, and the evidence behind each suggestion is one click away.
Challenges we hear
Claim and pre-auth files are long and messy
Cashless and reimbursement claims arrive as dozens of scanned pages in hospital-specific formats, and assessors re-key data before they can adjudicate.
Leakage hides in plain sight
Inflated bills, edited dates, reused documents and repair estimates that do not match the damage are hard to spot under daily volume.
Distribution conduct is under scrutiny
Agents, POSPs, bancassurance staff and now chatbots must explain exclusions, waiting periods and charges correctly, and mis-selling complaints are costly to investigate.
Service and renewal calls peak unpredictably
Renewal reminders, claim-status queries and hospital helpdesk calls compete for the same contact-centre capacity, often in several languages.
Where AI fits
Document Intelligence
Extraction and checking for claim files, pre-auth requests, broker submissions and policy wordings, with every field linked to its source page.
Computer Vision
Damage detection and photo-quality checks for motor claims and break-in inspections, plus image forensics for edited bills and reports.
Voice AI
Multilingual voice agents for renewal reminders and claim-status queries that verify the caller, use approved content and hand over to licensed staff.
AI Security & Compliance
Red-teaming of sales and service bots for mis-selling, missing disclosures, prompt injection and policyholder data leakage.
AI Sales & Marketing Automation
WhatsApp-first journeys that move agent and POSP prospects through onboarding and help active POSPs follow up on their customers' renewals.
Use cases
- Featured
Health Claim Document Extraction
Turn hospital bills, discharge summaries and investigation reports into structured, checked claim data, with uncertain fields routed to an assessor instead of guessed.
Pre-Authorisation Request Triage for TPAs
Read incoming cashless requests, check completeness, policy terms and tariffs, and put a prioritised, source-linked summary in front of the TPA medical officer.
Tampered and Fraudulent Document Detection
Score claim documents for signs of editing, fabrication and reuse, explain each signal, and route high-risk files to your investigation team instead of labelling anyone a fraudster.
Commercial Underwriting Submission Intake
Turn broker emails, proposal forms, schedules of values and loss histories into a structured, checked submission record, with gaps and appetite issues flagged for the underwriter.
Policy Wording Comparison Assistant
Align two or more policy wordings clause by clause, highlight what was added, removed, narrowed or broadened, and answer questions with citations to the exact clause.
- Featured
Motor Claim Damage Assessment from Photos
Detect damaged panels and damage types from guided claim photos, check them against the workshop estimate and pre-inspection images, and give surveyors a structured evidence pack.
Policy Renewal Voice Agent
A multilingual voice agent that calls policyholders before renewal, explains premium and cover from approved content, sends a UPI payment link and hands complex requests to licensed staff.
Claim Status Voice Helpline for Policyholders
An inbound voice agent that verifies callers, explains live claim status in plain language, sends pending-document lists on WhatsApp and transfers complaints and sensitive cases to people.
- Featured
Mis-Selling and Disclosure Testing for Insurance Bots
Test insurance sales and service bots for mis-selling, missing disclosures, prompt injection and data leakage, in English, Hindi and Hinglish, with transcript evidence for every finding.
Agent and POSP Lead Nurturing Automation
WhatsApp-first journeys that move agent and POSP prospects from sign-up to certification and first sale, and help active POSPs follow up on renewals with approved content.
Regulatory context
IRDAI regulations, master circulars and guidelines
IRDAI rules on policyholder protection, health insurance, claim settlement and information security set expectations on turnaround, disclosure, grievance handling and vendor risk. AI can prepare and flag work, while decisions and accountability stay with the insurer or TPA.
DPDP Act 2023 (India)
Claim files carry health and identity data. We build for purpose limitation, consent where required, masked logs and agreed retention, with Aadhaar handled per UIDAI rules.
TRAI commercial-communication rules
Outbound renewal calls and messages must follow TRAI's commercial-communication rules, including DLT registration of senders and SMS templates, and must respect customer consent and preference registrations.
EU AI Act and GDPR
For insurers serving EU customers, AI used for risk assessment and pricing in life and health insurance is classed as high-risk under the EU AI Act, alongside GDPR duties for personal data.
FAQs
01Will your AI approve or reject claims?
No. Our systems extract, check and flag; they do not adjudicate. Assessors, medical officers, surveyors and underwriters make every decision, and the system records what they changed and why.
02Do you work with TPAs and brokers as well as insurers?
Yes. Pre-authorisation triage and claim extraction suit TPAs, submission intake and wording comparison suit brokers and commercial underwriters, and POSP journeys suit both insurers and broking firms.
03Where is policyholder data processed?
In your cloud account or an India region of a major cloud provider, as your policy requires. Health and identity data is masked in logs, and we can use model endpoints that do not retain or train on your data.
04How do we start?
Usually with a three- or four-week pilot on one claim type, one product line or one bot, run alongside your current process. You get a working system, an accuracy or findings report and a costed production plan.
Related industries
Founded by Akhilesh Mittal. 8 years building a security platform for a New Zealand company. IIT ISM Dhanbad and IMT Ghaziabad. Builds production agentic AI.
Pick one claim type, product line or bot to start
Book a discovery call and we will scope a short pilot on your own de-identified documents or staging bot, with clear measures agreed up front.