Can AI approve your health insurance claim in under 5 minutes? ekincare thinks so

Health insurance claims in India are often slow, paperwork-intensive and frustrating for patients, hospitals and insurers alike. Digital health platform ekincare believes artificial intelligence (AI) can change that. Its acquisition of AI-powered claims startup Superclaims is designed to speed up claim approvals, reduce fraud and create a more connected healthcare ecosystem.

While the financial details of the deal have not been disclosed, the acquisition represents more than another health-tech transaction. It reflects a broader push towards AI-led automation in one of the most complex and resource-intensive parts of India's healthcare system.

Why did ekincare acquire Superclaims?

ekincare has built its business around corporate healthcare and employee wellness, serving more than two million employees across over 1,000 organisations. Its services have largely focused on outpatient (OPD) care, helping employers, employees and insurers manage routine healthcare more efficiently.

Hospitalisation-related inpatient (IPD) insurance claims, however, remained a missing piece of the platform.

According to ekincare Co-Founder and CEO Kiran Kalakuntla, delays in processing hospitalisation claims create inefficiencies for insurers while leaving patients uncertain about approvals and payouts. By acquiring Superclaims, the company aims to automate claims processing using AI and bring OPD and IPD services onto a single platform.

"Our larger vision and mission statement is to simplify healthcare," Kalakuntla said, adding that the combined platform aims to process both OPD and IPD claims in less than four minutes.

Superclaims will continue to operate independently as a wholly owned subsidiary of ekincare, with its existing leadership team continuing to manage the business.

Why do health insurance claims take so long?

Unlike routine reimbursements, hospital insurance claims involve multiple layers of verification before they can be approved. Insurers or third-party administrators (TPAs) need to verify the patient's diagnosis, treatment, policy coverage, exclusions, hospital bills and supporting medical records before deciding how much of a claim should be paid.

Many of these checks are still performed manually, particularly for cashless hospitalisation claims. That makes the process time-consuming, costly and prone to delays, especially when additional documents or clarifications are required.

As health insurers look to improve efficiency while managing rising claim volumes, AI-assisted claims adjudication is increasingly being explored as a way to automate routine verification without eliminating human oversight.

How does AI process an insurance claim?

Superclaims says it has automated much of the claims workflow using AI.

According to Founder and CEO Bhavish Ramaswamy, the company has developed a system comprising around 65 AI agents that collectively perform different stages of claim adjudication.

These AI systems verify medical necessity, review policy conditions, examine hospital bills, validate supporting documents and assess eligibility before arriving at a recommendation.

If the claim is straightforward, the AI completes the process from start to finish. Claims involving unusual treatments, conflicting medical information or other exceptions are escalated to human reviewers before a final decision is made.

"At Superclaims, the entire claim is adjudicated by AI end-to-end," Ramaswamy said.

Why is faster claim settlement important?

For most policyholders, the biggest source of frustration is uncertainty.

Once a claim is submitted, patients often have little visibility into whether additional documents are required, how much of the claim will be approved or when the insurer will communicate its decision. Depending on the complexity of the case, approvals can take anywhere from several hours to multiple days.

Superclaims says its technology can reduce approval times from around 90 minutes to under five minutes.

Faster settlements could also benefit hospitals by reducing administrative work and improving discharge processes, while insurers stand to lower operating costs through greater automation.

Can AI also reduce insurance fraud?

One of the biggest challenges for health insurers is identifying fraudulent or inflated claims without delaying genuine ones.

Kalakuntla said AI can help detect what insurers commonly describe as fraud, waste and abuse by identifying inconsistencies, unusual billing patterns and policy mismatches during claim assessment.

According to him, ekincare has already seen savings of between 3% and 5% in deployments where AI has been used across both OPD and IPD workflows.

Given that India's health insurers paid out more than ₹94,000 crore in claims last year, even relatively small improvements in claims efficiency could translate into significant cost savings across the industry.

Will AI replace human decision-making?

Not entirely.

Both companies emphasise that AI is intended to automate routine claims rather than replace human judgement altogether.

Claims involving complex medical conditions, conflicting clinical information or exceptional circumstances continue to be reviewed manually before a final decision is made.

Superclaims also says transparency has been built into its system.

"Whenever we adjudicate a claim, our AI always provides an explanation and the reasoning behind why a particular deduction has happened," Ramaswamy said.

Explainable AI is becoming increasingly important as insurers and regulators seek greater accountability in automated decision-making.

At the same time, AI systems remain dependent on accurate medical records, policy information and high-quality data. Cases involving incomplete documentation or unusual treatments are likely to continue requiring human intervention.

Why does this matter beyond faster claims?

The acquisition also reflects a broader shift in how healthcare technology companies are positioning themselves.

Rather than offering standalone digital health services, companies are increasingly attempting to connect employers, hospitals, insurers and TPAs on unified platforms that can exchange information more efficiently.

For ekincare, the acquisition extends its presence beyond employee healthcare benefits into hospital claims processing, bringing more parts of the healthcare journey onto a single platform.

The move also aligns with India's wider push towards digital healthcare through initiatives such as the Ayushman Bharat Digital Mission, which aims to improve interoperability and digital data exchange across the healthcare ecosystem.

What could the future look like?

The companies believe reducing claim approval times to under five minutes is only an early milestone.

As healthcare records become increasingly digitised and AI systems continue to improve, more routine claims could be processed almost instantly, allowing insurers to focus human expertise on more complex cases rather than standard verification tasks.

Whether that vision becomes reality will depend on wider adoption by insurers, hospitals and regulators, as well as the quality of healthcare data available for automated decision-making.

If AI delivers on its promise of making claims faster, more transparent and more accurate while maintaining appropriate human oversight, ekincare's acquisition of Superclaims could mark an important step in the evolution of health insurance claims processing in India.