Scaling Innovation in Healthcare Claims - with AI

Background

I built this feature from scratch at Nova Benefits, a Series A Insuretech startup in India in the Insurance broking and employee benefits space. I was leading the claims product charter, and had over a year already built out the core user flows, and API integrations with Insurers for claim processing. (Read more about that here). Although the product suite fared well against old school non-tech competitors, we were just about at parity with other InsureTech brokers. We needed to do more to differentiate, and win.

The Goal: Strategically Position Nova Benefits as the Tech Forward Broker of Choice through a 10x easier claims experience.

Why Focus on Claims? It’s the Broker’s Moment of Truth

Getting an insurance policy is just the beginning, and what really matters to the decision makers (Head of HR or CHRO) is the claims experience. In other words, that's the ROI on the policy. Healthcare claims are high frequency high impact touchpoints to demonstrate a great experience, and therefore have a better shot at winning new business or retaining existing ones.

The other side of the coin - claims test trust and operational efficiency like nothing else in the insurance business. Transforming this high-pain, high-frequency process into high quality experience strengthens Nova’s positioning as a leading player in the market.

User Problem: Filing reimbursement claims is an experience straight out of hell.

This is a standard claim form. An endless set of boxes with confusing information for anyone who doesn't work in Insurance. Take a moment to zoom in and see just how many fields there are! Now imagine printing these out on paper, filling this up (very carefully), and then scanning and uploading them. Worse, you could even have to courier the hard copies, depending on the Insurer.

What does the user really want?

Their money back - as quickly and painlessly as possible.

What was the playing field like?

Pretty outdated.

1. Traditional Brokers: Paper forms only.

2. Modern Insuretechs: Paper form scan and upload.

The Solution: MagicFill Forms with AI

MagicFill changed claim filing by:

1. AI Document Scanning: Extracting relevant bill amounts, bank details, etc from uploaded documents and writing it directly onto claim forms.

2. Auto-Completion: Pre-filling forms with KYC and policy data that we already had on our systems, dramatically reducing user effort.

3. Smart Attachments: Creating a claim "packet" and sending it to the Insurer via APIs.

   
   

   

   
   

Nuance

Claim forms contain a part B, filled up by the hospital on paper, at the time of discharge. Since we wanted an all digital experience, we had to partner with Insurers, and convince them to waive Part B.

Design Approach

Without going into detail, we banked on a lot of simulation before building.

1. PR/FAQ document - to nail down the desired customer impact.

2. A lot of prototyping, to get the "magical" part of MagicFill just right.

3. Marketing collaterals - created before a single line of code was written.

4. And not just fancy design, we had to establish even the right partnerships to enable a digital claim form - which is harder than it sounds if you're not the Insurer.

Driving and Measuring Success

The success of MagicFill will be measured against key metrics:

• North Star Metric: Percentage of claims processed end-to-end without manual intervention.

• Leading Indicators:

  • Client adoption rates for MagicFill - rapidly started climbing. In fact the first client was an inbound request from an HR manager who had seen the marketing video on LinkedIn.

  • Percentage of claims completed using document automation.

  • Reduction in claimant filing time.

• Lagging Indicators:

  • Average reduction in claim settlement times.

  • Client retention and renewal rates driven by superior claim experiences.

  • Improvements in Net Promoter Scores (NPS) tied to claims.

  
  

Strategic Impact: Differentiation… and a new business line.

1. Higher win/retention rates with the first real differentiator for the product suite

2. Opened up partnership discussions to even use the platform for a SaaS white-label play, hinging on this feature.

My Own Experience as a Claimant

I filed a claim for my mother, and it was a much much smoother experience than other claims my family has filed in the past.

I also noticed, that MagicFill was one part of the story - I found our entire Notifications layer (over WhatsApp and also email) worked extremely well, as did the operational team in getting my claim settled very quickly.

However, I also noticed some papercuts on the guidance we provide for documents to be uploaded - some simple copy changes could better describe what the claimant needs to upload.