CLAPi© Claims — Now Live
Transforming Accident & Health Insurance into a
Digital-First Ecosystem
Unified platform for Retail & Group Health Insurance with intelligent underwriting, automated claims, embedded insurance, portals, AI-powered workflows, and real-time servicing.
Industry Challenges
The Problems. The Solutions.
Legacy systems, fragmented data, and manual processes cost insurers millions. EnoviQ rewrites the rulebook.
⚠ Challenges
Legacy System BottlenecksMonolithic platforms unable to scale, integrate or innovate at speed.
Complex, Manual UnderwritingRule-heavy processes requiring heavy human intervention and inconsistent decisions
Slow Claims ProcessingDays or weeks to adjudicate claims, causing member dissatisfaction and cash flow issues
Fragmented Provider NetworksDisconnected hospital, TPA, and clinic ecosystems with no real-time data exchange.
Rising Fraud & Abuse RisksInsufficient detection tools leading to leakages of 5–10% of claims value.
Poor Member ExperienceLow digital engagement, opacity in claims, and zero self-service capabilities
Lack of Real-Time AnalyticsBlind spots in portfolio performance, loss ratios, and operational KPIs.
✦ EnoviQ Solution
AI-Driven AutomationEnd-to-end intelligent workflows with ML-powered decisioning replacing manual touchpoints.
Intelligent Claims AdjudicationAuto-adjudication engine processing claims in seconds with clinical and contractual rules.
Configurable Rule EngineNo-code business rule management for underwriting, rating, and claims decisioning.
Digital Provider EcosystemReal-time API connectivity with hospitals, TPAs, clinics, and surveyors.
Fraud, Waste & Abuse DetectionML-powered anomaly detection with pattern analysis across claims data.
Omnichannel PortalsMember, broker, employer, and provider portals with full self-service capabilities.
Real-Time Analytics & BILive dashboards on loss ratios, claims trends, portfolio health, and compliance.
Platform Capabilities
CLAPi© Claims Platform
10 integrated capability modules, purpose-built for the full Accident & Health insurance lifecycle.
Retail
Insurance
Insurance
Individual and family health policies with digital-first onboarding, instant quotation, and mobile-native member journeys from day one.
API-FIRST
Group
Insurance
Insurance
Employer-sponsored benefit plans with bulk enrollment, HR integration, corporate dashboards, and member lifecycle management at scale.
ENTERPRISE
Wellness &
Preventive Care
Preventive Care
Integrated wellness programs, preventive checkup benefits, health score tracking, and incentive management within the insurance product.
HEALTH-TECH
Provider
Management
Management
Hospital, clinic, TPA, and surveyor network management with real-time pre-auth, cashless processing, and provider performance analytics.
NETWORK
AI Claims
Automation
Automation
End-to-end intelligent claims processing from FNOL to settlement — auto-adjudication, document intelligence, and straight-through processing.
AI-POWERED
OCR & Document
Intelligence
Intelligence
Intelligent document processing for medical bills, discharge summaries, lab reports, and policy documents with structured data extraction.
OCR + AI
Rule Engine &
Rating Engine
Rating Engine
Configurable no-code rule management for underwriting, claims adjudication, rating factors, and product configuration.
NO-CODE
Policy
Administration
Administration
Full-lifecycle policy management — issuance, endorsements, renewals, cancellations, reinstatements — across all A&H product lines.
LIFECYCLE
Digital Portals
Ecosystem
Ecosystem
9 purpose-built portals spanning customer, member, broker, employer, provider, TPA, surveyor, mobile, and distribution channels.
OMNICHANNEL
Real-Time
Analytics
Analytics
Unified BI platform with live claims dashboards, loss ratio tracking, fraud indicators, underwriting intelligence, and regulatory reporting.
REAL-TIME BI
Insurance Ecosystems
Retail & Group — One Platform
Dual-mode insurance operating system powering both individual and corporate health insurance at enterprise scale.
Retail Insurance
Individual & Family Health | Mobile-First | Digital-Native
Individual & Family Policies— Flexible covers, riders, and benefit configurations.
Digital Onboarding— eKYC, digital proposals, instant policy issuance.
Instant Quotation Engine— Real-time premium calculation.
Claims Tracking — Transparent real-time claim status with member notifications.
Wellness Integration— Preventive care benefits, health rewards, and wellness scoring.
Self-Service Portal — Full member lifecycle management via web and mobile app.
Renewal Automation — Intelligent renewal nudges, auto-renewal, and lapse prevention.
Group Insurance
Employer-Sponsored | Corporate Benefits | HR-Integrated
Employer & HR Portal— Corporate admin dashboard for benefit management.
Bulk Enrollment — Mass onboarding via Excel upload, HR APIs, or web portal.
Employee Benefits Administration — Flexible benefit plans, sum insured, and graded covers.
HR Portal Integration — API connectivity with Workday, Oracle HR, and more.
Corporate Dashboards — Utilization analytics, claims trends, and cost reports.
Member Management — Additions, deletions, mid-term modifications, dependents.
Group Claims Servicing — Employer-view claim dashboards with cost intelligence.
Built to power both Retail and Group Health Insurance ecosystems through one unified platform — one configuration, one data model, one intelligence layer.
Digital Portal Ecosystem
9 Portals. Zero Friction.
A complete omnichannel servicing ecosystem connecting every stakeholder in the health insurance value chain.
Customer Portal
End-to-end digital journey from quote to claims. Policy management, document downloads, and real-time support.
WEB + MOBILE
Member Portal
Cashless claim intimation, pre-auth tracking, wellness benefits access, and hospital network lookup for insured members.
SELF-SERVICE
Broker Portal
Policy sales, quotation tools, commission tracking, renewal management, and complete customer portfolio view for brokers.
DISTRIBUTION
Employer / HR Portal
Corporate group policy administration, bulk enrollment, benefit configuration, claims reporting, and workforce analytics.
HR-INTEGRATED
Provider / TPA Portal
Cashless pre-auth submissions, claim intimation, real-time adjudication status, and digital settlement for network providers.
NETWORK
Embedded Insurance Portal
White-label insurance widget APIs enabling third-party platforms — banks, fintechs, aggregators — to embed products seamlessly.
API-FIRST
Mobile Applications
Native iOS and Android apps for members, customers, and brokers with biometric auth, push notifications, and offline capability.
MOBILE-FIRST
Investigator Portal
On-site claim assessment workflows, digital photo capture, geo-tagging, and real-time report submission for field Investigator.
FIELD
Distribution Portal
Multi-channel sales management across agents, corporate accounts, bancassurance, and digital aggregator partnerships.
CHANNEL
End-to-End Insurance Journey
From Prospect To Claim Resolution
The complete digital insurance lifecycle — 6 stages, one intelligent platform, zero handoff friction.
Customer
Onboarding
eKYC & ID Verification
Digital Proposal
Risk Profiling
Member Enrollment
Pre-existing Review
Quote &
Underwriting
Risk Scoring
Rule Engine Check
Premium Calculation
Quote Generation
Acceptance Decision
Policy
Issuance
Real-Time Issuance API Integration Digital Policy Kit Payment Gateway e-Signature
Policy
Servicing
Endorsements Renewals Benefit Updates Member Changes Reinstatements
Claim
Management
FNOL & Pre-auth Auto Adjudication Fraud Detection Provider Coord. Settlement
Insights &
Analytics
Live Dashboards Loss Ratios Business Intel. Fraud Reports Compliance BI
EnoviQ Differentiators
Why Leading Insurers Choose EnoviQ
Built by insurance technologists, for insurance enterprises. Every feature earned in production with real carriers.
10x
Faster Product Launch
New insurance products live in weeks, not months, using the Excellator no-code configuration engine.
500+
APIs Ready to Use
Pre-built REST APIs for every insurance function — policy, claims, payments, portals, and integrations — available day one.
100+
Products Configured
Battle-tested across health, accident, critical illness, group, retail, and embedded insurance product configurations globally.
40+
Countries Supported
Multi-currency, multi-language, multi-regulatory environment support for global and regional insurance market deployment.
99.9%
Platform Uptime SLA
Cloud-native architecture on AWS/Azure with auto-scaling, disaster recovery, and enterprise-grade security certifications.
<5s
Claim Adjudication
AI-powered straight-through processing delivering sub-5-second adjudication for qualifying claims — no human touchpoint required.
9
Portal Ecosystem
Customer, member, broker, employer, provider, TPA, surveyor, mobile, and distribution portals in one unified system.
No Code
Excel-to-API
EnoviQ's Excellator converts actuarial Excel models into live, production-grade API endpoints — zero developer effort for business teams.
TRUSTED BY LEADING INSURERS ACROSS ASIA, MIDDLE EAST & AFRICA
Ready to Transform?
Build The Future Of Health Insurance With
CLAPi© CLaims
Deliver smarter underwriting, faster claims, connected portals, and seamless member experiences through one intelligent digital platform.
Let's Get Your Project Started!
Packages
À la carte Capabilities
- Hong kong
- Singapore
- India