Health insurance
Almara
Claims settled before the file gets cold
- Sector
- Health insurance
- Location
- Abu Dhabi, UAE
- Year
- 2026
- Kickoff to production
- 18 weeks
Claims adjudication for a health insurer: the routine majority settle themselves, and the rest reach a reviewer with the rules already applied.
Outpatient claims took nine days and three pairs of hands. Benefit limits were read out of a policy PDF by whoever picked up the file, so identical claims got different answers and providers chased payment by phone.
- 01
Benefits as rules
Policy wordings became a versioned rule set with dates, limits and exclusions, so an outcome traces to a clause rather than to a colleague.
- 02
Adjudicate on arrival
Eligibility, coding and pricing run the moment a claim is submitted. Anything clean and inside limits is priced and approved without joining a queue.
- 03
A reviewer's file, pre-built
Claims that need judgement arrive with line items, rules applied, provider history and the single question that needs answering.
Most outpatient claims now settle the same day, provider chase calls collapsed, and the medical team reviews the claims that genuinely need a clinician.
What changed
- Routine outpatient claims
- Same day
- Straightforward majority
- Auto-adjudicated
- On complex cases
- Medical time
Stack
- Next.js
- Python
- Postgres
- Temporal
- HL7 FHIR
Disciplines applied
- AI solutions
- Automation & operations
- Financial technology
