Short answer
Claims management software runs a claim from first notice of loss (FNOL) to settlement: intake, document and photo capture, assignment to adjusters or surveyors, reserves, approvals, payments and recovery. Infikey builds claims platforms with customer apps, AI document extraction and fraud flags. Typical builds cost USD 40,000–100,000.
Updated · Written by the Infikey Technologies delivery team
Claims workflow features
| Stage | Features |
|---|---|
| FNOL | Web, app, WhatsApp and call-centre intake, policy validation, coverage checks |
| Evidence | Photo and video upload, document checklists, OCR of bills and estimates |
| Assignment | Rules-based routing to adjusters, surveyors, garages or hospitals by location and skill |
| Assessment | Reserves, assessment reports, video surveys, approval limits by role |
| Settlement | Payment to customer or provider, deductible handling, settlement letters |
| Recovery | Subrogation, salvage and reinsurance recovery tracking |
| Oversight | SLA timers, ageing reports, complaint links, audit trail of every decision |
Where AI helps, and where it should not decide alone
- Document extraction: reads hospital bills, repair estimates and invoices into structured fields for review.
- Triage: separates simple claims for fast-track handling from complex ones that need an expert.
- Fraud signals: duplicate invoices, unusual timing, repeated providers or edited images are flagged for investigation.
- Customer updates: plain-language status messages generated from claim events.
Final decisions stay with a person, with the reasons recorded. Regulators such as IRDAI in India, the FCA in the UK and US state insurance departments expect fair, explainable claims handling. See our AI services for how we build reviewable AI features.
Cost
| Scope | Budget (USD) | Budget (INR) |
|---|---|---|
| Claims workflow for one line with customer portal | 40,000–60,000 | 32–50 lakh |
| Multi-line claims with surveyor and provider apps | 60,000–100,000 | 50–80 lakh |
| Add AI document extraction and fraud flags | +15,000–30,000 | +12–25 lakh |
These are planning ranges, not quotes. The AI automation ROI calculator helps size the savings from automation.
Project blueprint
Claims workflow for a health insurance third-party administrator
Based on the requirements we hear most often from buyers like this.
A third-party administrator processes health claims from hospitals and members. Documents arrive by email and courier, claims sit in shared inboxes, and members call repeatedly for status updates.
What we would build
- Claim intake from hospital portal, member app and email
- Document checklists with OCR of bills and discharge summaries
- Rules-based routing to medical and claims teams by complexity
- Approval limits, settlement letters and payment files
- Fraud flags for duplicate bills and unusual patterns, reviewed by staff
How success is measured
- Claim turnaround time from complete documents to decision
- Claims returned for missing documents
- Status calls from members and hospitals
- Flagged claims confirmed as leakage