CLAPi© Claims Management

One Claims Engine.
Every Line of Business.

CLAPi©'s Claims module processes Health, Life, and P&C claims — intake through settlement — on a single cloud-native engine. No separate systems, no re-keyed data, no fragmented view of a claimant.

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Breadth of coverage

One platform that's fluent in Health, Life & P&C —
not just bolted together

Most claims platforms are built for one line of business and stretched to cover the rest. CLAPi© Claims was architected the other way: a single claims data model and workflow engine, with LOB-specific rules configured on top.

Health

Individual & Group

  • Cashless pre-authorization & LOG/LOC issuance
  • Reimbursement claims with document inward & discrepancy handling
  • Provider network, panel & tariff management
  • Benefit-level adjudication (co-pay, deductible, limits)
Life

Individual & Group

  • Death, maturity & rider benefit claims
  • Beneficiary & nominee validation
  • Policy status & waiting-period eligibility checks
  • Payee & payout settlement
P&C

Property & Casualty

  • Loss intimation, claim registration & investigation
  • Surveyor & provider portal workflows
  • Fee schedule & bundled payment calculation
  • Fraud, waste & abuse screening at claim entry
Built-in Intelligence

Auto-adjudication that thinks like an underwriter

CLAPi© Claims runs every claim — regardless of LOB — through configurable rules before a human ever needs to look at it.

✓ Cause-of-loss, diagnosis & exclusion validation — medical codes, peril codes, or policy exclusions, whichever applies
✓ Waiting-period fulfilment based on diagnosis, treatment, or date of loss
✓ Blacklisted or suspicious provider, repairer, or vendor detection
✓ Policy & insured status checks for the claim period
✓ Claim amount & coverage limit validation
✓ Salvage & subrogation recovery identification
✓ Litigation flagging & legal reserve tracking
✓ Flexible approval workflows for multiple payees & bulk payments
Get loss / pre-authorization details /api/Claims/ClaimPreAuthList
Trigger assessment & adjuster check /api/Claims/ClaimAssessor
Run adjudication against UW rules /api/Claims/ClaimAdjudication
Identify suspected fraud & abuse /api/Claims/ClaimNotification
Get policy benefit / coverage utilization /api/Claims/MemberBenefitUtilization
Flag salvage & subrogation recovery /api/Claims/ClaimSubrogation
Track litigation & legal reserve status /api/Claims/ClaimLitigation
Set final claim status /api/Claims/ClaimStatus
Fraud, Waste & Abuse

Claims are scored before they're paid

Every claim, across every LOB, is weighted against past experience and known fraud patterns before settlement.

Suspicious Transaction
Management
Flags claims for review based on medical necessity, high-risk providers, non-emergency care delivery, and provider-practice trends — with alerts raised before processing.
Claims
Scoring
Each claim is weighted by relevance and history to generate a cumulative suspicion score, evaluated against a threshold tuned from prior claim experience.
Deep-Learning
De-duplication
Goes beyond phone, email, name and DOB matching — which can be altered — to catch duplicate claimants and members at onboarding.
Why insurers choose CLAPi© Claims

The claims edge, across
every book of business you write

01
One Platform, Every LOB
Health, Life and P&C claims run on the same engine — eliminating the reconciliation work of running three systems.
02
Paperless By Design
An integrated Document Management System handles storage, indexing, access control and audit trail for every claim document.
03
API-First Architecture
500+ APIs ready to use — claims intake, adjudication, and settlement all expose clean endpoints for integration.
04
Proven at Scale
Live in production across insurers and brokers and TPAs in Asia Pacific — running Health, Life and P&C claims on the same deployment, not a pilot.

Stop Running Three Claims Systems
For One Book Of Business.

See how Health, Life and P&C claims settle on a single engine — live, on your own claim scenarios.

Let's Get Your Project Started!

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