Claim status, any channel
“Where is my claim?” answered end-to-end on WhatsApp, voice, SMS or web.
Gooclaim OS
Use case · Health insurance
For health. The pilot vertical, ready today.
Health is where Gooclaim OS goes first — because it is where the broken communication layer hurts most. Full workflow coverage for cashless, query, document collection and rejection-reason, all template-only, all audited.
IRDAI 1hr / 3hr readyDPDP consent gate7-year audit ledger
The problem · in one number
75–80%
of all insurance grievances in India are health
Health complaints doubled in six years. ₹26,037 Cr of claims rejected in FY24. 13% rejected, another 9% repudiated. Most are process failures, not policy denials.
IRDAI Annual Report 2024-25 · Bima Bharosa · Moneylife
What Gooclaim OS does for Health
Pending-doc workflow
Multi-day, durable, never-loses-state document collection — patient uploads, claim moves.
Reason-for-rejection
Safe templated explanations of why a claim was repudiated, with next-step actions.
1hr / 3hr cashless SLA
Per-tenant SLA observability against the IRDAI cashless mandate.
Multi-lingual outbound
Hindi · English · Hinglish + regional — every claimant on their terms.
Templates-only safety
Every outbound passes the 4-tier policy gate — no free text on health PII.
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 Ops
Owns the 75-80% complaint share that lands on health.
TPA Leadership
Owns the cashless clock and per-claim economics.
Hospital Chain Ops
Owns discharge predictability across every TPA partner.
Health is the wedge. The OS is the moat.
We start with health because it bleeds the most. The same platform then expands to Life, Motor and beyond — without a rebuild.