Health Insurance

Flexible Policy Administration, Smarter Claims Processing and Efficient Fraud Management

Manorama’s Health Insurance suite is designed to cater the growing requirements of the payer- provider’s ecosystem. This product addresses the needs of end-to-end insurance processes of HMO, Insurance Company, Health Insurance Broker and Third Party Administrator. With our deep domain expertise, we have also entered the micro-insurance market.

The Solution is capable of running a large scale UHC project with the capacity to handle multiple insurance schemes on it. We have designed robust fraud detection and prevention system to reduce the leakages in the insurance system.

Challenges in Insurance Processes

How our System Overcome these Challenges

Payer and Provider systems not integrated

Integrated in a unified platform

Prevalence of Fraud

Fraud Prevention measures implemented

Time consuming manual claim processing

Auto Claim Processing configuration implemented

Lack of analytical tools

Analytics dashboard for actionable insights

Insurance Suite Module Catalogue

Centralized Insurance Scheme Configurator
Member Data Management
Plan Comparator
Provider / Network Management
Premium Management
Master Data Management
Pre-Authorization and Claims Submission
Pre-Authorization and Claims Processing
Fraud Prevention and Detection
Claim Finance
Access Control
Reports

Solution Highlights

Availability of Insurance Data & Tracking
Insurance Company & Plans Enrollment
Hospital Empanelment
Biometric Verification and OTP
Claim Settlement & Batch Payments
Claim Screening at various level
Tracking of Referral Clinics & Referral Patients
Dashboards for Optimization
Compliant with Medical Audits
Fraud Detection & Flagging
Balance Check Limit
Real-time Claims Tracking & Processing
MIS Reports
Live Status Tracking of Preauthorization and Claim
Customizable Insurance
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