Health Insurance Claims Processing Software

Assure Tech Pro is an AI-powered health insurance administration and claims processing platform for TPAs, HMOs, insurers, and other healthcare payers. It combines policy administration, pre-authorization, claims adjudication, provider management, AI document processing, medical validation, fraud controls, accounting, CRM, and reporting.

AI can extract information from claim documents and hospital bills and convert unstructured medical information into structured claim data. Assure Tech Pro then applies configured policy, benefit, tariff, medical, fraud, and adjudication rules to process eligible cases and route exceptions for human review.

Yes. Its AI-assisted document processing can extract member, provider, diagnosis, procedure, and other relevant information from authorization documents. Extracted information can then be matched against member, policy, provider, and benefit records.

Yes. Assure Tech Pro can extract structured information from claim PDFs and associated medical documents, including member and provider information, diagnosis and procedure information, dates, charges, and relevant medical coding where available.

The platform can use ICD diagnosis and CPT procedure information, together with other supported coding systems such as CDT and ICD-PCS where applicable, to perform configured medical and claims validation checks.

Assure Tech Pro combines extracted claim information with policy benefits, exclusions, limits, tariffs, deductibles, copayments, authorization information, and configured adjudication rules to calculate applicable payable and non-payable amounts.

Yes. Hospital bill items can be extracted and categorized and then evaluated against provider tariffs, packages, policy benefits, quantities, deductibles, copayments, and other configured rules.

Yes. Configurable hospitalization rules can use diagnosis and other clinical information to establish expected or authorized length-of-stay parameters. Cases exceeding those parameters can be flagged for medical review.

The platform can apply configurable fraud, utilization, medical, billing, tariff, duplicate, and historical rules to identify potentially abnormal claims. Suspicious cases can be escalated to audit or investigation teams rather than being automatically treated as fraudulent.

The platform can integrate with an AI-powered WhatsApp assistant that allows authenticated members to access supported information such as claims, authorizations, benefits, medication history, pharmacy/provider information, and other member services.

Not necessarily. Assure Tech Pro supports human-in-the-loop workflows. Claims that fail configured rules can be routed to claims processors, doctors, auditors, investigators, or supervisors for further review.

Yes. The platform covers core TPA operations including member management, provider networks, pre-authorizations, claims, medical adjudication, tariffs, capitation, finance, CRM, grievances, reporting, and regulatory workflows.

Yes. HMOs can use the platform for member administration, provider network management, authorization, claims processing, capitation, utilization management, customer service, and financial operations.

Yes. Its API-driven architecture is designed to support integration with insurer, broker, hospital, provider, mobile, portal, payment, and other approved third-party systems.

Assure Tech Pro is designed for health insurance operations across markets including India, the UAE, and Saudi Arabia, with country-specific workflows, configurable regulatory integrations, and support for multiple languages and currencies.

Yes. Depending on the implementation architecture, the platform can support cloud, private-cloud, on-premise, and hybrid deployment models.