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Study about the SEWAs insurance Claim procedure compliancy and its management


  • Shubhangi Bochare
  • Agency :
  • Objective : The study is to assess the existing process of claims  settlement  product  wise  and  to  put  in  place, effective process of claims settlement to reduce percentage of pending claims.
  • Background :
  • Methodology : This Evaluation study was carried out to Measure the average time required for claims settlement and   reasons   for   delays   in   claim   settlement.      419 mediclaims and 94 life insurance claims was studied. Both primary and secondary data was used.
  • Findings :
    It suggests that every insurance scheme have different lacuna in process. In life insurance unnecessary steps are carried out, and manual entry consumed more time. In case of mediclaim average time consumed in each process is more as no special person is appointed for handling claim settelment, filing system is not present, and in cashless system there was problem in module which produces incorrect report. Proper reporting system and follow up by improving monitoring of pending claims is necessary. Evaluation of cashless claim suggest that CTF reduce burden of patients from cash transactions, also reduce the time consumed in settlement of claim but still the  administrative  costs  related  to  claims  servicing  is higher as compare to the normal claims and the quality of services provided to members need further improvement. Process of handling the claims can further strengthen if the awareness of members is improved by the help of aagewan ben  and  checks  should  be  kept  on  the  provider  and claimant.

  • Recommendations : the  administrative  costs  related  to  claims  servicing  is higher as compare to the normal claims and the quality of services provided to members need further improvement. Process of handling the claims can further strengthen if the awareness of members is improved by the help of aagewan ben  and  checks  should  be  kept  on  the  provider  and claimant.
The study is to assess the existing process of claims settlement product wise and to put in place, effective process of claims settlement to reduce percentage of pending claims