Star Health, India’s largest retail health insurer, has announced a significant move to modernize its claims operations by outsourcing a substantial part of its claims processing to a third-party administrator, Medi Assist. This partnership will leverage Medi Assist’s AI-driven MAtrix platform to enhance claims processing efficiency, accuracy, and fraud detection capabilities. The MAtrix platform utilizes intelligent automation and real-time data integration to streamline workflows, reduce manual intervention, and deliver quicker settlements, ultimately leading to a better customer experience.
According to Anand Roy, MD & CEO of Star Health, this partnership is a key milestone in the company’s journey to build a technology-led, agile claims infrastructure. The goal is to improve speed, accuracy, and consistency in claims management, while also addressing fraud, waste, and abuse. The collaboration is expected to redefine industry standards in technology-driven operations, said Medi Assist CEO Satish Gidugu.
The MAtrix platform provides a range of features, including a rules-based adjudication engine, AI co-pilot features, and machine learning tools to enhance fraud detection. The system is integrated with Star Health’s internal architecture, ensuring scale, real-time exchange, and compliance with the National Health Claims Exchange framework. Additionally, the partnership introduces AI-powered customer engagement tools, such as chatbots and virtual assistants, with omnichannel availability via mobile apps and WhatsApp.
The adoption of the MAtrix platform is expected to bring several benefits to Star Health, including improved claims processing efficiency, enhanced customer experience, and better fraud detection capabilities. The platform’s AI-driven tools will help reduce waste, eliminate manual intervention, and streamline workflows, leading to quicker settlements and increased policyholder satisfaction. With this partnership, Star Health aims to establish a transparent and reliable claims service, setting a new standard in the Indian health insurance industry. Overall, the collaboration between Star Health and Medi Assist is a significant step towards modernizing the claims ecosystem in India, leveraging technology to improve efficiency, accuracy, and customer experience.