agentic ai - Health Insurance / Mediclaim
OmniClaim Sentinel®
An end-to-end AI-powered claims management platform for health insurers, designed to automate adjudication, eliminate fraud, and optimize member experiences. Built on Microsoft’s ecosystem, it transforms legacy claims processing into a proactive, intelligence-driven workflow.
OmniClaim Sentinel® embeds AI directly into claims workflows via Dynamics 365 CE and Power Platform. It reduces processing time from days to seconds while using Microsoft Fabric to unify data from EHRs, billing systems, and IoT devices.
Processes 300+ claim types using configurable business rules.
Integrates with 40+ EHR systems via Azure API for FHIR.
Flags 15+ fraud typologies (e.g., upcoding, unbundling) with 98.5% accuracy.
Generates audit-ready case files in Power Apps.
Power BI dashboards track lifetime value, claim risk scores, and retention likelihood.
Sends personalized plan recommendations via Dynamics 365 Marketing.
Ingest structured (EHRs, policy databases) and unstructured data (clinical notes, invoices) via Microsoft Fabric Lakehouse.
FHIR-compliant APIs for Epic/Cerner EHR interoperability.
Legacy system integration through Azure Synapse pipelines.
Only solution using generative AI to predict unknown fraud vectors.
Unified Microsoft stack eliminates integration debt.
Real-time provider collaboration tools.
AutoAdjudicate Engine
Uses Dynamics 365-based business rules and Azure Machine Learning to process routine claims in <10 seconds. Cross-references EHR data, policy terms, and treatment histories to auto-approve valid claims while flagging discrepancies.
FraudRadar AI
Leverages Microsoft Fabric’s real-time analytics and generative AI to detect novel fraud patterns (e.g., phantom billing, identity theft). Continuously learns from global claims databases and adapts to emerging threats.
BenefitOptimizer
Analyzes member behavior via Power BI dashboards to recommend personalized coverage upgrades, predict claim likelihood, and reduce claim denials by 35%.
Provider Nexus Portal
Embedded Power App allowing hospitals to submit pre-validated claims, track approvals in real-time, and resolve disputes via Dynamics 365 case management.
Health Insurance / Mediclaim
Power your AI transformation
Predict, Prevent, Prosper
From forecasting claim surges to preempting fraud, OmniClaim Sentinel® turns reactive workflows into strategic growth engines.
Approve Claims in 10 Sec, Not 10 Days
AI automates 85% of routine claims, cutting processing costs by 40% and boosting member satisfaction.
Spot Fraud Before It Costs You Millions
Generative AI detects new fraud patterns in real-time, reducing losses by 50% with zero false positives.
Turn Claims Data into Retention Gold
Predictive analytics identify at-risk members for proactive outreach, slashing churn by 25%.
Hospitals Love Us, Fraudsters Fear Us
Provider portal cuts claim resubmissions by 60% while FraudRadar blocks $3M+ in scams monthly.
No More Guesswork in Coverage Plans
BenefitOptimizer uses 200+ data points to design personalized plans that reduce claim denials by 35%.
Microsoft-Powered, Future-Proofed
Built on Dynamics 365 and Fabric, it scales securely with your business—no legacy migration needed.
Explore purchase options
Choose the OmniClaim Sentinal® plan that fits your needs, or connect with Sales to get personalized recommendations.
Get Started
Try OmniClaim Sentinal® free
Contact our Agentic AI solution expert to setup a sandbox for you absolutely free.
- No credit card information required.
- Use trial capacity on OmniClaim Sentinal tool.
The AI Sentinel for Modern Insurers
OmniClaim Sentinel® uses Dynamics 365 and Azure AI to process claims in seconds, block evolving fraud, and personalize member experiences—all on one compliant platform.
Cut Costs, Not Corners
Achieve 99.7% claims accuracy with zero fraud slippage. Our Microsoft Fabric-backed engine audits every claim in milliseconds.
Let AI Handle the Grunt Work
Free adjusters from routine claims with AutoAdjudicate, while FraudRadar arms them with actionable intelligence to combat sophisticated scams.