CASE SUBMISSION

ROUND

NAVI RETAIL HEALTH

INSURANCE

SUBMITTED BY:
TEAM ONE MAN ARMY
 HOW >90% OF CUSTOMERS WILL BE ABLE TO GET CASHLESS PROCESSING
• Notification snippets can be sent on the mobile
• implement online underwriting to assess the devices as it is one of the most efficient way to  reach
risks and provide convenient online quotes. out to the customers. 

• Educate the customers regarding the list of
network hospitals with which Navi/ its TPA
has a tie-up so that the patients will be aware
of the list of hospitals that they can visit to
• This is most efficient in planned treatment such as
knee replacement Surgery, cataract surgery,
Maternity, gallbladder removal and many more..
Incase of any emergency and has to be hospitalized
on an immediate basis, then the dynamics would be

PHASE-I claim the process that too cashless.  different. 

• Also focus on points such as higher claim
settlement ratio and also faster settlements in
PHASE-II
cashless than reimbursements. 
• Sending important emails/WhatsApp message and
also SMS’s  regarding the updates of the list of
hospitals added or removed from the network of
hospitals were we provide insurance. Considering
our age range of our TG it is easy to educate them
too.

We can bring in the behavioural shift within the existing and also the
potential customers or leads within the next 6 months following these
steps.
 HOW >90% OF FRAUDS COULD BE CAUGHT UPFRONT
In many big hospitals these days recording (audio or video or both) of
medical procedures such as surgeries take place or in the least the on duty
doctor makes notes of the  process happening, those data could be set up
in a cloud space such that even the insurance provider/ (TPA) could verify
the data.
Once the hospital or the patient has an idea about the fact the it extremely
difficult to fraud/Scam Navi especially at the initial stage then due to the
psychological reasons such as GAS (General Adaptation Syndrome)
Neither hospitals nor patients will not try to cheat us.
In case of any suspicion we will ask the Hospital to Send all the Lab
Reports, Bills and Doctor's Prescription in Original while patient is
Hospitalized. And we run a verification process from our end if any
discrepancy found they ask with hospital to send stronger evidence.
With the database we have we can run a random forest algorithm
(Machine Learning) and train the model and since we have a time
period of 6 months we can test the model as well and also understand
whether the claim is fraudulent or non fraudulent.
 Spoke to an Have gone through the To Understand the
administrator handling reports to Research cashless claims
R this function about the Dynamics of
the “Retail Health
processing in detail.
and to Understand
E Insurance Industry ” different types of frauds
in the Retail health
F Insurance Industry.

E NEELIMA HOS
PITAL ERRAG
Government of
India Reports
YouTube

R ADDA

E
N
C
E Thank you!
S Submitted by: Team ONE MAN ARMY

Abhiram Molugu