Claim status, answered from the record
On WhatsApp and email, in English, Hindi or Hinglish — with the source and the date the record was read.
Gooclaim OS
Use case · Health insurance
For health. Where we started. Running today.
Health has the strictest clock in Indian insurance, which is why it is where Gooclaim OS runs first: claim status, document collection, the reason behind a decision and the complaint that follows — all on the record, all in the member's language.
IRDAI 1 hr / 3 hr / 15 daysDPDP consent at step zero10-year audit ledger
The problem · in one number
39.57 lakh
claims that missed their settlement deadline
A government audit counted them. Almost none of those were hard decisions — the claim was waiting on a document, a clarification or a reply, and the waiting was nobody's job. The 2024 circular made that waiting expensive: interest runs from intimation, and the claim cannot be closed for want of documents.
CAG performance audit, Report 11 of 2023 · IRDAI circular, 5 September 2024
What Gooclaim OS does for Health
Document collection that survives days
A durable workflow that waits, reminds, accepts the file, checks it and puts it where the TPA's system expects it — without losing its place.
Why a claim was decided that way
The reason in the record, explained in approved wording, with the next step the member can actually take.
Every clock the circular sets
1 hour for cashless authorisation, 3 hours at discharge, 15 days from submission — counted per claim, with the interest estimated as it runs.
A complaint is its own thing
It gets its own deadline, the member's own words, and the decision sent back to them — not folded into the claim it came from.
Nothing free-text, ever
Templates only, every value matched to the record, and the whole message checked before it leaves. On health data that is not a preference.
Who this is for
Three people own this in your org.
Gooclaim OS shows up first for these roles — but the platform serves the entire claim chain.
Health insurer, customer operations
Owns what a member hears between intimation and settlement.
TPA leadership
Owns the cashless clock and the cost of every claim that stalls.
Compliance
Owns the NL-48 return, the ombudsman file and the DPDP position.
Health first. Because its clock is the strictest.
Gooclaim OS is built on what every claim shares — a status to tell, documents to collect, a reason to explain and a clock to beat. Motor and life are new workflows on the same core, not a rebuild.