S S Gopalarathnam,
Managing Director, Chola MS

S S Gopalarathnam, Managing Director, Cholamandalam MS General Insurance Company Ltd, talks to Monalisa, Elets News Network (ENN), about how automation, right from sales to workflows, enables seamless communication

What are the most pressing challenges for health insurance companies in India?
The most pressing challenge for a health insurance company is to avoid any kind of leakages / fraud / over-billing during claims. We believe that up to 30 percent of the total health claims paid in a year are due to these factors. It is important that such frauds are completely controlled, else the profitability of health portfolio of any insurance company will always be under pressure.

How can IT help address other issues such as frauds in claims, data management, etc?
When large volumes of data are analysed, patterns of frauds do emerge whether there is a nexus between hospitals, patients and treatments being provided. Data can also throw aberrations where one particular claim is large as compared to same treatment for other patients elsewhere. Medical treatment has evolved in countries like the USA where uniform standards and codes are followed across hospitals, pharmacies, insurance companies, etc, resulting in faster claim settlement, subrogation claims as well as detection of frauds. We will find the same happening in India as well.

How has technology adoption impacted your operations?
Sales automation through Health Proposal on the GO enables our agents to distribute and sell policies to the end-customer through mobile devices. Capture of information like personal details, photos and scans and upload of information from anywhere, helps in instant issue of policies by mail.
Fax automation through Right Fax server, enables all hospitals to send fax. This is automatically mailed to approving authorities, who are able to validate and verify the data and provide the necessary approvals. The TAT for cashless approvals has been 35 minutes last year, one of the best in the industry.
Workflow automation of health proposal has again improved transparency across stakeholders, reduced TAT, etc. Automatic escalation lets in quicker disposal of proposal quotes. Workflow automation of claims is underway for Health LOB.
Moreover, a mobile app Wellness is being developed. This will have many features for the customers such as his health card on mobile; QR code capturing his policy details; a tracker to follow-up on his medical fitness levels like BMI, blood sugar etc; a pedometer to track his exercise regimen; a GPRS-enabled hospital locator, and so on. This will be supplemented by a hospital app to read the health card and trigger cashless approvals.

In what ways can Information Technology help fill the gap between insurance companies, TPAs and hospitals?
Information Technology can help fill the gap on information availability between Insurance Companies, TPAs and Hospitals which will have benefits on many fronts. This will help reduce the turnaround time (TAT) for cashless approvals which also gives the end-user a great mental relief and assurance. This shall also enable streamlined flow of information from hospitals to TPAs, as required for claim settlement by insurance companies, thus avoiding repeat requests for documents and increase FTR percent.

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