SOC Claims Intelligence Platform
Every Rupee Your Claims Team Pays Out Deserves a Second Opinion.
InsurNest's SOC Claims Intelligence Platform validates every claim line-item against your Schedule of Charges in real time — catching overbilling, duplicates, and fraud before the payment clears.
Your Claims Team Is Fighting a Losing Battle
Every day, insurance carriers and TPAs process thousands of claims against a Schedule of Charges that runs into hundreds of line items — manually. The result is predictable: financial leakage, fraud that slips through, and a compliance team buried in paperwork.
Financial leakage is systemic
Industry estimates suggest 3–8% of total claims paid are erroneous or fraudulent. For a carrier processing ₹100 Cr in claims annually, that's ₹3–8 Cr walking out the door every year — silently.
Manual SOC matching doesn't scale
A claims examiner can cross-reference 40–60 claims per day against the SOC. Your inbound volume is 400. The math doesn't work — and errors compound with fatigue.
Duplicate claims are invisible
The same claim resubmitted with a different date or a slight name variation passes manual checks 80% of the time. Providers know this. Some exploit it.
One SOC doesn't fit all
Your northern hospitals, southern clinics, and pharmacy networks are on different rate schedules. Without automated routing, the wrong SOC gets applied — and the claim either overpays or creates a dispute.
Anomalies hide in volume
A provider billing ₹182 when the SOC says ₹170 — on every single claim — is invisible to a human reviewer. AI sees it in milliseconds.
Compliance risk is growing
IRDAI scrutiny on claims accuracy is intensifying. A claims operation running on spreadsheets is one audit away from a serious compliance event.
Six AI Modules. One Unified Claims Intelligence Platform.
OCR + AI Document Parsing
Claim documents arrive as scanned PDFs, handwritten forms, Excel files, and mixed attachments. Our AI reads all of it — extracting every field with 95%+ accuracy, flagging low-confidence extractions for review, and normalising data into a clean structure. What this replaces: manual data entry. Completely.
SOC Master Management
Create, version, and approve your Schedule of Charges with a governed workflow — four-eye approval, full version history, and automatic activation on the effective date. Every change is audited. No more "which Excel file is current?"
Multi-SOC Routing
Define your SOC landscape by region, provider type, and policy — and the engine routes every claim to the correct schedule automatically. North Zone hospital claims go to one SOC. South Zone pharmacy claims go to another. No manual selection. No routing errors.
SOC Matching Engine
Every claim line-item is validated against the applicable SOC — checking rate compliance, code validity, quantity limits, and authorisation requirements. Compliant claims are cleared. Non-compliant items are flagged with plain-language explanations.
Duplicate Claim Detection
A fingerprint is computed for every claim and checked against a rolling 180-day index. Exact duplicates are blocked immediately. Near-duplicates — with slight name variations, shifted dates, or inflated amounts — are caught by fuzzy matching and surfaced side-by-side for comparison.
Anomaly Detection
AI builds a billing profile for every provider. Systematic overbilling, upcoding, unbundling, and frequency spikes are detected by comparing each provider's behaviour against statistical baselines and peer group benchmarks.
Measurable Impact. From Day One.
4 hrs — Claim processing time
Down from 3–5 days. Claims that once took days to adjudicate are validated end-to-end in hours, freeing your team for exceptions that genuinely need human judgment.
95% — SOC compliance accuracy
Up from ~75% manual. Every line-item checked against the correct SOC version, every time — with no fatigue, no shortcuts, and a full audit trail.
40% — Financial leakage stopped
Year 1 reduction. Carriers and TPAs recover material value in the first year simply by catching what manual review was missing.
90% — Duplicate detection rate
Of true duplicates caught before payment. Exact and near-duplicate claims are flagged using fingerprint matching and fuzzy similarity scoring across a rolling 180-day index.
95% — OCR extraction accuracy
Field-level accuracy across scanned PDFs, handwritten forms, and mixed attachments. Low-confidence extractions are automatically flagged for human review.
70% — Manual review effort saved
Hours per week returned to your team. Reviewers stop doing data entry and start doing what they were hired for — making decisions on complex claims.
How we compare to the alternatives.
| Feature | SOC Claims Intelligence | Generic CMS | Manual Process |
|---|---|---|---|
| AI document extraction (any format) | Partial | ✗ | |
| Line-item SOC validation | ✗ | Manual | |
| Multi-SOC routing by region + provider type | ✗ | ✗ | |
| Duplicate detection with fuzzy matching | ✗ | ✗ | |
| Anomaly detection + provider risk scoring | ✗ | ✗ | |
| Plain-language rejection notices | ✗ | Manual | |
| Full audit trail per claim | Partial | ✗ | |
| SOC version control + approval workflow | ✗ | ✗ | |
| REST API integration | Depends | N/A | |
| Processing time | < 30 sec | Minutes | Days |
Built for every layer of the insurance value chain.
Built on Trust. Proven by Practice.
Enterprise-Grade Security
AES-256 encryption at rest. TLS 1.3 in transit. SOC 2 Type II aligned controls. Your claim data never leaves your approved infrastructure boundary.
IRDAI Compliance Ready
Audit trails designed for IRDAI inspections. Every claim decision documented with timestamp, SOC version, and rationale.
99.5% Uptime SLA
High-availability architecture with automated failover. 4-hour RTO. Built for mission-critical operations.
Human-in-the-Loop
No black boxes. Every AI flag includes a plain-language explanation. Humans retain final decision authority on every claim.
DPDP Act Compliant
Patient data handling designed for India's Digital Personal Data Protection Act. Data residency controls included.
Insurance-Native
Built exclusively for insurance — not adapted from generic software. Deep domain expertise in Indian and global insurance operations.
Ready to Stop Claims Leakage?
Book a 30-minute demo and we'll show you exactly how much your current process is costing — using your own claims volume as the baseline.
No obligation. We reply within one business day.
Meet Our Innovators:
We aim to revolutionize how businesses operate through digital technology driving industry growth and positioning ourselves as global leaders.
Insurnest
Empowering insurers, re-insurers, and brokers to excel with innovative technology.
Insurnest specializes in digital solutions for the insurance sector, helping insurers, re-insurers, and brokers enhance operations and customer experiences with cutting-edge technology. Our deep industry expertise enables us to address unique challenges and drive competitiveness in a dynamic market.