Paz Claims AI: Fixing the Most Broken Part of Healthcare Insurance

If you ask employees and HRs where their insurance breaks, the answer is always the same: claims.

At Pazcare, our data shows that 20% of reimbursements get stuck in insurer and TPA queries. These claims can stretch beyond 30 days. For the employee, that’s uncertainty at the worst possible time. For the HR, it means firefighting escalations. And the root cause is simple: documents. One missing prescription, one unclear bill, and the claim goes into a loop.

We knew this was the biggest gap to solve. That’s why we built Paz Claims AI.

Why Claims Break Down

Reimbursements are document-heavy. If one paper is missing such as a doctor’s note, a pharmacy bill, ore a doctor’s note, a pharmacy bill, a discharge summary, the insurer raises a query. Employees re-upload, TPAs recheck, and weeks are lost in back-and-forth.

This broken process leaves:

• Employees frustrated and anxious
  
• HRs stuck chasing insurers
  
• Insurers spending unnecessary time on rework

How Paz Claims AI Solves This

We asked ourselves a simple question: what if we could stop claims from going wrong at the very beginning?

Here’s what we built:

• Error detection at source → When an employee uploads documents, our AI reviews them instantly. Missing fields, unclear bills, or unsigned prescriptions are flagged right there.
  
• Disease-specific knowledge base → Over 3 years, we’ve built a proprietary dataset of required documents for every treatment type — maternity, surgery, dialysis, and more. No guesswork, no repetitive queries.
  
• Fraud detection baked in → Duplicate entries and suspicious bills are flagged before they reach the insurer.
  
• Real-time visibility → Employees and HRs get live status updates and expected TATs. No more chasing for answers.

The Impact

With Paz Claims AI, reimbursement queries have dropped to almost zero.

• Claims get settled in days, not months
  
• Employees have less stress during a vulnerable time
  
• HRs don’t need to chase insurers and TPAs
  
• Insurers save costs and reduce rework

Everyone in the ecosystem wins.

Beyond Claims

Claims are the most broken part of insurance, but they’re not the only pain point. Over the last 3 years, we’ve also:

• Built deep API integrations with insurers for faster onboarding
  
• Leveraged LLMs for document reading to cut errors and reduce costs
  
• Automated endorsement workflows so HRs don’t get stuck in admin
  

Now, we’re building the next set of AI-powered workflows to further reduce administrative hassle for customers, cut opex costs for insurers and TPAs, and drive higher margins for us.

Why This Matters

At the end of the day, claims are the moment of truth in insurance. If we can make claims smooth, fast, and transparent, we rebuild trust in the system.

That’s why we’ve put Claims AI at the center of our product vision. Insurance shouldn’t feel like a battle of documents. It should feel like support when you need it the most.

And with Paz Claims AI, that’s exactly what we’re delivering.

Reach out to me on sanchit@pazcare.com or message me on LinkedIn if you’d like to explore this technology or discuss how you can leverage it for your organization.