Core Claims Operations Engine

The engine behind
every claim.

VINGS runs the entire policy and claim lifecycle for Payers — Member Enrolment, Empanelment, Product & Policy configuration, Pre-Authorisation, Claim Processing, Financial Operations, and Re-Insurance, all in one connected system.

VINGS — End-to-End Claims Lifecycle
Claim #VNG-8821
Apollo Hospital, Mumbai · IP Cardiology
Step 01 / 10
Claim Submission
Submission
Eligibility
Pre-Auth
Doc Intake
AI Process
FWA Screen
Adjudication
Appeals
Payment
Settlement
Claim Submission
VINGS Core
CPT 47600 · ICD K80.2 · ₹30,200 billed
Apollo Hospital, Mumbai — IP Cardiology
1 / 10
150M+
Lives on platform
Automated
Adjudication engine
99.9%
Uptime SLA
20+
Years domain depth
The Challenge

Why insurers are
losing ground.

Legacy infrastructure isn’t just slow — it compounds into billions in fraud, operational failure, and member attrition every year.

Fragmented
Infrastructure
Fragmented Infrastructure

Policy, claims, network, fraud, and billing run on separate legacy systems with no shared data layer.

Slow
Adjudication
Manual, Slow Processing

Manual data entry slows every decision. Members wait days for approvals that should be instant.

Rising
Fraud exposure
Unchecked Fraud Leakage

Static rule engines miss dynamic fraud patterns. Organised schemes evolve faster than legacy systems respond.

Manual
Network operations
Provider Network Friction

Credentialing driven by email and spreadsheet. No real-time network visibility or contract lifecycle management.

VINGS Platform

One platform. Every insurance workflow.

VINGS is the shared intelligence layer that unifies claims, fraud detection, provider networks, and member experience — eliminating the fragmented stack.

Claims

End-to-end claims administration — pre-authorisation, adjudication, appeals, and payment — automated on the VINGS shared data layer.

Pre-auth automationAI-powered adjudication
AutomatedEnd-to-end claims

FWA

Clinical AI + 10,000+ cognitive rules detect fraud, waste, and abuse before payment — across every claim, every provider, in real time.

Pre-payment fraud scoring10,000+ clinical rules
10K+Clinical fraud rules

Provider

Provider empanelment, credentialing, contract lifecycle, and performance management — fully automated across the network.

Automated credentialingContract management
E2EProvider lifecycle

ENIGMA

AI document intelligence that extracts structured data from any format — handwritten forms, PDFs, images — feeding directly into FWA and Claims.

Universal document extractionMulti-language support
Any formatDocument extraction

Policy

Build, issue, and manage any policy type — individual, group, or government — with full automation from product config to document generation.

Flexible product builderAutomated renewals
FlexiblePolicy configuration

Member

White-label member portal and mobile app — claims filing, provider search, benefits view, and real-time status — built on the VINGS data layer.

Digital claims filingProvider search & discovery
White-labelMember experience

Analytics

Cross-module intelligence: loss ratio, fraud trend analysis, utilisation, actuarial modelling — all refreshed live from the VINGS data bus.

Loss ratio analyticsFraud trend reporting
LiveUnified dashboards
Ready to see these modules in action?
A 30-minute demo tailored to your workflows — we walk through the modules most relevant to you.
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Workflow Orchestration

From first request
to final payment.

Six orchestrated stages. Every handoff automated. Every decision tracked.

Pre-Auth
Pre-Authorisation

Clinical guidelines applied in real time. Standard procedures auto-approved. Complex cases reviewed with supporting clinical rationale.

Input — Treatment request from provider or member
Output — Fast approval or denial. Provider notified instantly.
ClaimsClinical RulesRapid · Decision speed
Screen
Fraud & Document Check

ENIGMA extracts structured data. FWA scores against 10,000+ indicators. Suspicious patterns isolated before adjudication begins.

Input — Claim submission with supporting documents
Output — Clean claim proceeds. Flagged claims routed to SIU.
FWAENIGMA10K+ · Clinical fraud rules
Adjudicate
Claims Adjudication

Claims auto-adjudicated by AI with support for ICD 9/10 AM/CM codes, CPT, CDT, and Drug codes. Complex cases pre-loaded with full context — clinical history, provider profile, FWA score — for specialist review.

Input — Screened claim with FWA score, documents, policy terms
Output — Fast decision for auto cases. Full audit trail generated.
Claims IntelligenceAI-powered · Claims adjudication
Appeals
Appeals & Review

Structured appeals workflows triggered automatically. Policy terms cross-referenced. Reviewers receive full decision history — no context rebuilding required.

Input — Denied claim and member or provider dispute
Output — Resolved appeal with documented rationale.
ClaimsPolicyStructured · Appeals workflow
Pay
Settlement & Payment

Automated payment trigger on approval. Reconciliation runs without intervention. Audit trail auto-generated. Member notified in real time.

Input — Approved claim and provider payment instructions
Output — Same-day settlement. Full reconciliation records.
ClaimsProvider NetworkSame day · Settlement speed
Optimise
Analytics & Learning

Unified analytics surface loss ratio, fraud trends, and utilisation. AI models retrained on live data. Actuary dashboards auto-refreshed without manual extracts.

Input — All events from every prior stage
Output — Operational intelligence. Model improvement. Regulatory reports.
Analytics HubLive · Data freshness
150M+
Lives
Pan-Asia
Operations
Enterprise
Scale
Multi-market
Reach
20+
Years

See VINGS running your insurance operations.

Our solutions team will walk you through a demo built around your exact workflows, volumes, rules, regulatory environment, and scale. No generic slides.

No commitment required
Tailored to your workflow
Response within 24 hours