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From paper proposals to straight-through insurance operations

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We modernise policy admin, claims and agent distribution for insurers, brokers and TPAs, so issuance and settlement keep pace with IRDAI timelines.

Parts list

  1. Policy admin modernisation
  2. Digital proposal and issuance
  3. Agent and POSP apps
  4. Digital claims intake
  5. Hospital bill extraction
  6. Fraud scoring
Project
Insurance
Discipline
Digital transformation
Drawn by
Nexzem engineering
Scale
Not to scale

The insurance value chain is still full of manual handoffs

Insurance runs on documents. Proposal forms are filled by agents and rekeyed at the branch, underwriters chase medical reports over email, and claims teams read hospital bills line by line to decide what is payable. Many insurers and brokers still depend on a policy administration system built two decades ago, with product changes requiring vendor change requests and long test cycles.

The rules have shifted underneath these processes. IRDAI's 2024 health insurance master circular sets tight timelines for cashless authorisation and discharge, the regulator is pushing electronic policies and the Bima Sugam marketplace, and its information and cyber security guidelines raise expectations on controls. The National Health Claims Exchange is standardising how hospitals and payers exchange claims data.

Nexzem approaches insurance transformation by product line and by journey. We pick one line, such as retail health or motor, digitise its proposal-to-policy and claim-to-settlement flows end to end, and use that as the template for the rest. Legacy policy systems are wrapped first and replaced only when the new platform carries real volume.

Insurance, drawn as a phased roadmap

Workstreams down, phases across. An illustrative sequence; your roadmap is set after the first audit.

Ph 1

Ph 2

Ph 3

Ph 4

Ph 5

  1. Policy admin modernisation
    Phases 1 to 2
  2. Digital proposal and issuance
    Phases 1 to 2
  3. Agent and POSP apps
    Phases 2 to 2
  4. Digital claims intake
    Phases 2 to 3
  5. Hospital bill extraction
    Phases 3 to 4
  6. Fraud scoring
    Phases 3 to 3
  7. Renewal and retention analytics
    Phases 4 to 5
  8. Partner and TPA integration
    Phases 5 to 5
  1. Ph 1

    Line-of-business selection

    We pick the product line where digitisation will show the clearest gain and map its full lifecycle.

  2. Ph 2

    Journey and rules design

    Proposal, underwriting and claim rules are documented with underwriters and claims heads before build.

  3. Ph 3

    Wrap the legacy PAS

    APIs around the existing policy system let new journeys go live without a risky replacement.

  4. Ph 4

    Pilot and measure

    The new journey runs with a subset of agents or partners, and we track turnaround and quality against the old path.

  5. Ph 5

    Scale across lines

    The proven template rolls out to other products, and AI models are added where data volume supports them.

Insurance transformation initiatives

Modernise policy administration, claims and distribution so insurers, brokers and TPAs work from one digital flow.

  1. 01

    Policy admin modernisation

    A configurable product and policy engine that lets actuaries and product teams launch riders and plan variants without hard-coded changes to the legacy PAS.

  2. 02

    Digital proposal and issuance

    Guided proposal journeys with e-KYC, e-sign, premium payment and instant policy PDF generation, replacing paper forms and branch rekeying for retail lines.

  3. 03

    Agent and POSP apps

    Mobile tools for agents and point-of-sale persons covering quoting, lead tracking, renewals, commission statements and training content in local languages.

  4. 04

    Digital claims intake

    First notice of loss through app or WhatsApp, with photo and video surveys for motor claims and document upload checklists that reduce incomplete submissions.

  5. 05

    Hospital bill extraction

    OCR and language models that read discharge summaries and itemised bills, map line items to policy terms and flag non-payable charges for adjudicators.

  6. 06

    Fraud scoring

    Network and anomaly models that link claims sharing hospitals, garages, phones or bank accounts, routing suspicious cases to investigation before payment.

  7. 07

    Renewal and retention analytics

    Lapse prediction and next-best-offer models that tell service teams which policyholders to contact first and what product to discuss at renewal.

  8. 08

    Partner and TPA integration

    API connections with hospitals, TPAs, banks and aggregators, including readiness for NHCX claim exchange and future Bima Sugam marketplace listings.

Why choose Nexzem for insurance transformation

  • R-01

    Faster issuance

    Clean digital proposals cut rekeying and underwriting queries, so customers receive policies sooner.

  • R-02

    Settlement within timelines

    Automated document checks and bill extraction help claims teams meet regulator-mandated turnaround times.

  • R-03

    Lower leakage

    Fraud scoring and rule checks catch inflated or duplicate claims before money goes out.

  • R-04

    Products without vendor queues

    Configurable product rules let your team launch variants without waiting on change requests.

  • R-05

    Empowered distribution

    Agents and partners get tools that make selling and servicing easier, which helps retention.

How insurance transformation unfolds, phase by phase

Sheet P-01, delivery sequence

Clear stages with a review at the end of each, so you always know what happens next and what it costs.

  1. S1

    Line-of-business selection

    We pick the product line where digitisation will show the clearest gain and map its full lifecycle.

  2. S2

    Journey and rules design

    Proposal, underwriting and claim rules are documented with underwriters and claims heads before build.

  3. S3

    Wrap the legacy PAS

    APIs around the existing policy system let new journeys go live without a risky replacement.

  4. S4

    Pilot and measure

    The new journey runs with a subset of agents or partners, and we track turnaround and quality against the old path.

  5. S5

    Scale across lines

    The proven template rolls out to other products, and AI models are added where data volume supports them.

Insurance transformation in practice

  • Detail A

    Digital issuance for health insurance

    A health insurer lets customers and agents complete proposals digitally with automated underwriting rules, issuing straightforward policies instantly and routing complex cases to underwriters with all documents and risk flags attached.

  • Detail B

    Claims intake with document AI

    Hospital bills, discharge summaries and claim forms are read automatically, key fields extracted and checked against policy terms, so claims teams review exceptions instead of typing data from scanned documents.

  • Detail C

    Agent app for a life insurer

    Agents generate illustrations, complete digital proposals, collect premiums and track renewals from a mobile app connected to the policy system, reducing paperwork and speeding up issuance for new customers in the field.

  • Detail D

    Renewal retention analytics

    An insurer predicts which policies are at risk of lapsing, prioritizes outreach by agents and digital reminders, and measures which interventions actually improve renewals across products, channels and regions each quarter.

Digital Transformation for Insurance, in depth

Sheet N-01, general notes

N1

Where legacy systems hold insurers back

Many insurers run policy administration systems built decades ago, sometimes on mainframes, where launching a new product or changing a rating rule requires scarce specialists and long release cycles. Distribution, claims and customer service grow around these cores with separate tools, connected by batch files and manual handoffs between teams.

Customers feel it at the moments that matter most: buying a policy and making a claim. Paper-heavy proposals, slow underwriting, unclear claim status and repeated document requests damage satisfaction and renewals. Agents and partners struggle with portals that do not work well on mobile phones. Our insurance industry page describes the journeys insurers typically modernize first. Meanwhile, regulators expect faster claim decisions, stronger cyber security and better customer protection, which legacy processes find hard to meet consistently. Transformation is increasingly a compliance need as well as a growth opportunity.

  • N1.aNew products delayed by policy system limitations.
  • N1.bManual underwriting and document checks.
  • N1.cClaims status invisible to customers and agents.
  • N1.dSeparate systems for each channel and partner.
  • N1.eLimited data for fraud detection and pricing.
  • N1.fAgent portals that work poorly on mobile phones.
N2

A phased insurance transformation roadmap

Start by building an integration layer around the policy administration system, so new digital journeys can quote, issue and service policies without changing the core. Digital proposal and issuance, agent apps and digital claims intake then follow, delivering faster turnaround and better experiences quickly. Document AI for claims and hospital bills reduces manual effort at the same time.

Later phases modernize the core itself, often product line by product line, and add fraud scoring, renewal analytics and partner integrations with third-party administrators and hospitals. IRDAI requirements on cyber security, policyholder protection and claim timelines shape each phase; this is general information, not legal advice. Our AI development services support the document and fraud models many insurers adopt.

  • N2.aPhase 1: integration layer around policy administration.
  • N2.bPhase 2: digital proposal, issuance and agent apps.
  • N2.cPhase 3: digital claims intake and document AI.
  • N2.dPhase 4: core modernization by product line.
  • N2.ePhase 5: fraud, pricing and retention analytics.
  • N2.fOngoing: training, change management and regular reviews.
N3

Measuring insurance transformation progress

Insurance transformation should show up in turnaround times, costs and customer outcomes. Policy issuance time, the share of policies issued straight through without manual intervention, claim settlement time, cashless authorization times and renewal rates are the core indicators, alongside complaint volumes and agent productivity. Track fraud detection outcomes carefully, balancing caught fraud against false alarms that delay genuine claims. Clear measures per phase help steering committees decide where to invest next and demonstrate improvements to regulators and partners.

  • N3.aPolicy issuance turnaround and straight-through rate.
  • N3.bClaim settlement and cashless authorization times.
  • N3.cRenewal and persistency rates.
  • N3.dCustomer complaints per thousand policies.
  • N3.eAgent productivity and digital adoption.
  • N3.fFraud detection rate and false positives.
  • N3.gTime to launch a new product or rider.

Technology for insurance transformation

Proven, well-supported tools chosen for your scale, budget and team, never for novelty.

  • React
  • Flutter
  • Node.js
  • Python
  • Java
  • PostgreSQL
  • Elasticsearch
  • Hugging Face
  • Azure

Insurance transformation FAQs

Something else on your mind? Ask a consultant and get a reply within one business day.

Can you work with our existing policy administration system?

Yes. We usually integrate with the current PAS through APIs, database views or batch interfaces first. Replacement is planned only when the new configurable engine has taken over real volume and the business case is clear.

Is AI used to approve or reject claims automatically?

We design AI to assist adjudicators, not replace them. Models extract data, check documents and score risk, but the decision stays with a claims professional, with every recommendation logged for audit.

What affects the cost of an insurance transformation project?

Cost depends on the product lines in scope, integrations with PAS, TPAs, hospitals and payment partners, document volumes for AI extraction, and security requirements. A phased fixed quote follows a free consultation.

How do you address IRDAI cyber security expectations?

We build with encryption, role-based access, logging and vulnerability testing, and we support your information security team with documentation for audits under IRDAI's information and cyber security guidelines.

How long does a digital claims rollout take?

A digital FNOL and claims workflow for one line typically goes live in 12-16 weeks. Bill extraction and fraud models are added once enough claims history is available to tune them.

How do we modernize without disrupting existing policyholders?

We add new digital journeys through an integration layer while existing policies keep running on the current system. Core modernization then happens product line by product line, with data migrated carefully and parallel runs that confirm calculations before each cutover.

Can you integrate with third-party administrators and hospitals?

Yes. We build integrations with TPAs, hospital networks and partners using APIs where available and file-based exchanges where needed, with validation, retries and audit logs so claim data flows reliably and traceably between all parties.

We work with clients across the USA, UK, Australia, UAE, New Zealand and India.

Where we work

Start with a clear roadmap.

Share where your systems and processes stand today. We reply within one business day with a suggested first phase.