Built for every claim.
Every channel. Every CMS. Every workflow.
A claim is decided by a system. It is moved by people.
Watch this one. The record stays correct the whole time — and nothing in it can ask anyone for the document it is waiting on.
Every field is correct. Nothing in it can ask anyone for the document.
Not our numbers. The regulator’s, and the auditor’s.
India · health insurancehealth claims settled in a year
claims that missed their deadline
to settle, from submission
penalty, for exactly these failures
A claim is decided by a system. It’s moved by people — and there aren’t enough of them.
India settles 3.26 crore health claims a year against a one-hour legal clock. The decision is rarely the problem. Claims stop between the steps — and since 2024, every day they wait costs money.
The TPA must collect documents from the hospital — not the member. No claim may be closed for want of them.
About 1 in 5 rejections were never medical — an unanswered query or a missing document. Since 2024 those claims cannot be rejected, so they stay open, with interest running.
The decision has an owner. The movement doesn’t.
“We sent the bill.”
Holds: The documents and the bill
“The insurer decides.”
Holds: The claim record and the workflow
“The TPA holds the data.”
Holds: The decision and the money
“Nobody tells me anything.”
Holds: Nothing but the wait
Gooclaim OS moves the claim. It chases what is owed, watches every clock, and tells the member — all on the record, without replacing the system that decides.
How it worksBuilt around the claim, not one line of insurance.
Every claim — health, motor or life — has the same moments: a status to tell, documents to collect, a reason to explain and a clock to beat. Gooclaim OS is built on those. We started where the clock is strictest: health.
Your claims system records the claim. Gooclaim OS moves it.
Keep the system you have — it stays the source of truth. Gooclaim OS reads it and never writes to it. What it adds is everything that has to happen between the steps.
Correct, and complete for what it was built to do.
- Day 0ClockOn record
Claim intimated. The 15-day clock starts, and so does the interest meter.
Six things it was never built to do. Six jobs Gooclaim OS takes on.
The legal clock
Your claims system
Stores dates. Runs no countdown and cannot say what a late claim is costing.
Runs the 1-hour, 3-hour and 15-day clocks on every claim, with the interest at stake.
Missing documents
Your claims system
Marks the claim “deficient”. Nothing asks, reminds or escalates.
Asks for what is owed, reminds on a schedule, and hands it to a person when nobody answers.
Your team’s work list
Your claims system
A list sorted by date. No way to see which claim is closest to its limit.
Orion puts the claim nearest its limit on top, with the next safe step and its evidence.
The member
Your claims system
A row in a table. No channel, no language, no thread.
Answered on WhatsApp or email, in their language, with the source and date.
What goes out
Your claims system
No check on a message before it reaches a member.
Approved templates only. Every value is checked against your record before sending.
What was said
Your claims system
Logs decisions and field changes — not the words sent to the member.
Every message on a tamper-evident ledger, with its source and date.
Claim intimated. The 15-day clock starts, and so does the interest meter.
The claim does not change. What happens to it does.
One OS. Three jobs done.
Gooclaim OS is a Claim OS: one agentic core that talks to your members, works beside your team, and keeps every claim on the record.
What your member sees. An answer, not a helpline number.
A member asks on WhatsApp or email, in their own words. The OS checks who they are, reads your claims system, and replies in an approved message — with the source and date, and the next thing they need to do.
- Consent first
DPDP consent before a single claim detail.
- Verified
On WhatsApp, the registered number. On email, a code sent to it first.
- Source & date
Every answer names whose record it read, and when.
- Never free text
Approved templates only, in the member's language.
The same checks on every new channel — consent, verification, approved wording and the record.
From first call to first member reply. Four steps.
No rip-and-replace. Gooclaim OS sits on top of the systems you already run, and nothing reaches a member until your team has approved it.
- Step 1
Connect your claims system
By API, a secure file drop, or a batch upload. Your knowledge library joins the same way.
YoursRead-only. Nothing is ever written back.
- Step 2
Approve your messages
Every member message, in each language, in your own words.
YoursNot one can be sent until your team approves it.
- Step 3
Test on your own claims
A testing stage with sample claims, on every channel and language, with the evidence.
YoursYou sign it off before anything goes live.
- Step 4
Go live, watched
One workflow at a time. The first days are monitored closely.
YoursAny workflow pauses in a click.
30 minutes · real workflows on a sample claims system · no slides
The questions TPAs ask. Answered plainly.
No. Gooclaim OS reads from the claims system you already run — by API, a secure file drop or a batch upload — and never writes back to it. Your system stays the source of truth.