Case Study – Retail Health Insurance

Navi is building businesses across all verticals of BFSI. Goal is to be a one-point destination for all the
financial products a person in our TG (Age: 25 to 40 years & Income: 5-15 Lacs) requires at various
stages of their lifecycle.

For each of the products which we are building, our focus is to design something which is most customer
centric possible.

One of the products Navi has launched is Retail Health Insurance, where anyone can take Health
insurance for themselves or for their families.

● Most of the Retail Health Insurance Sales happen via Brokers or agents. Navi is focusing on
Direct to customers. This is to own the value chain and be closest to the customer.
● Most of the market is offline while Navi has taken a digital only strategy. This is to bring
transparency along with speed and simplicity.

There are two major problems which exist in this industry traditionally:

1. Customer experience due to a large proportion of claims being settled in India via
Reimbursement (~50%), while rest as Cashless. Reimbursement is an extremely painful process
and takes upto 4 weeks and many iterations.
2. This Industry is fraud prone and Insurance companies end up paying a significant amount of
money where claims were falsely raised but could not be identified as Fraud by the claims
processing team.

Navi is trying to achieve below:

1. >90% of customers should be able to get cashless processing
2. >90% of frauds should be caught upfront

Please create a strategy which can enable Navi to achieve its above objectives in the next 6
months.

Pointers:

● Please understand the dynamics of “Retail Health Insurance” Industry through someresearch
● Understand cashless claims processing and reimbursement claims processing in detail.
● Understand different types of frauds along with their contribution in the Retail health
Insurance Industry.