Reads the system you already run
By API, a secure file drop or a batch upload — whichever your platform speaks. Read-only: nothing is ever written back.
Gooclaim OS
Use case · TPAs
For TPAs. The claims that stop moving, and nobody is told.
A claim waiting on one document can sit for weeks while the clock runs, because asking for it is somebody's manual job. Gooclaim OS reads your existing claims system, asks the member itself, and keeps every clock and every message on the claim.
Read-only on your CMSIRDAI clocks per claimOne deployment, tenant from login
The problem · in one number
5%
of health claims were still open when the year ended
On every one of those days the 2024 circular runs interest at bank rate + 2% from the date of intimation, paid by the insurer of its own motion — and the same circular says a claim cannot be closed for want of documents. So an unanswered document request is not a backlog item. It is a meter.
IRDAI Annual Report 2024-25 · IRDAI circular, 5 September 2024
What Gooclaim OS does for TPAs
Asks the member, and counts
A document request becomes a message with an upload link, a reminder on day 7 and 14, and a final notice on day 21 with a ticket for your team. The claim is never closed for it.
Checks the file before you see it
Is it readable, is it the document it was sent as, is it this member's? A file seen on another claim or marked as AI-generated is flagged for a person — never refused on its own.
The clock on every claim
1 hour, 3 hours and 15 days from submission, counted per claim with the interest already estimated, so a breach is visible before it is a payment.
Audit ledger per tenant
Append-only, SHA-256 chained, 10-year retention — and the NL-48 TAT report built from the record itself, frozen with its checksum.
Your wording, approved first
Templates only. Every value in a message is matched back to the record it came from, and nothing leaves until your team has signed the wording off.
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.
Head of Claims Ops
Owns the 1 hour and 3 hour windows, and the queue nobody can see the bottom of.
COO
Owns the interest that accrues on open claims, and the insurer relationships it costs.
Compliance Officer
Owns the IRDAI trail, the NL-48 return, and what the ombudsman is shown.
The claim keeps moving while nobody is watching it.
Your people decide the claims. The chasing, the counting and the record of what the member was told stop being somebody's memory.