Medical Claims Automation Qorus-NTT DATA Innovation in Insurance Awards 2026

Submitted by

Al Rajhi Takaful

Premium

09/03/2026 Insurance Innovation

Our GenAI medical claims assistant is designed to improve the speed, accuracy, and consistency of medical claims processing. The solution understands and continuously learns from approved medical guidelines, benefit rules, and historical claims decis

Innovation details

Country
Saudi ArabiaCategory
GenAI Innovation of the YearKeyword
AI & Generative AI, Health insurance, Claims managementBusiness Line
Health InsuranceDistribution Channel
Agents, Bancassurance, Brokers, Online / Direct, Partners

Innovation presentation

The Problem:

Medical claims processing is complex, manual, and highly dependent on individual expertise. Claims teams must interpret medical guidelines, policy coverage, and clinical documentation under time pressure, leading to delays, inconsistencies, and higher error rates.

The Solution:

We implemented a GenAI claims assistant that understands medical guidelines and applies them to claims analysis. The assistant reviews clinical documents, maps treatments to guidelines and coverage rules, flags discrepancies, and provides clear reasoning and outcomes for human review.

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