Insurance Platform Case Study – Insurtech Claims Processing
The Insurance Platform project modernized a legacy insurance operation spanning policy servicing, underwriting, claims intake, adjudication, and partner settlement. The client, a high-growth insurer with mixed legacy and manual workflows, struggled with fragmented data, long claim cycles, and rising fraud pressure. Code Ninety built an integrated Insurtech platform in 10 months to centralize policy and claims workflows while enabling straight-through processing for low-risk claims. The platform now supports 3.8 million active policies and 1.4 million+ annual claims across health, motor, and property lines. By introducing event-driven workflows, fraud risk scoring, and partner APIs, the insurer transformed processing speed and operating efficiency, reducing average settlement time and increasing adjudication consistency.
Client Background
The client is a regional insurer with strong distribution through bancassurance and agency networks. Rapid policy growth outpaced operational systems, resulting in claims backlogs and inconsistent partner servicing. The insurer operated separate claims systems for health and motor products, with offline reconciliation for finance and reserve calculations. Strategic objectives were clear: reduce claim turnaround, lower handling cost, improve anti-fraud controls, and provide real-time performance visibility to business heads and regulators.
The Challenge
The program involved six major constraints. First, multi-line product complexity: health, motor, and property claims required different workflows and approval controls. Second, operational latency: manual document checks and multi-stage approvals caused high settlement cycle times. Third, fraud and leakage: fragmented analytics prevented early risk detection. Fourth, ecosystem integration: hospitals, workshops, TPAs, and surveyors required secure external access and standardized data exchange. Fifth, compliance and audit readiness: approvals, reserves, and payouts needed traceability for internal audit and regulator reporting. Sixth, migration sensitivity: cutover could not interrupt active claims or policy servicing windows.
Competing proposals offered either expensive product customization or long transformation timelines with uncertain outcomes. Code Ninety was selected for its execution model, domain-led architecture, and measurable transformation roadmap tied to claims KPIs.
The Solution
Unified Insurance Core
Code Ninety implemented a modular insurance core for policy servicing, endorsements, and claims life-cycle management. Product configuration was rule-driven to support line-of-business differences without code-level changes for every policy variant.
Straight-Through Claims Automation
Low-risk claims were routed through automated adjudication using eligibility, coverage, historical utilization, and document completeness checks. Claims exceeding risk thresholds were escalated to adjusters with structured work queues, SLA clocks, and evidence trails.
Fraud Scoring and Leakage Control
A risk engine combined rule-based triggers with model scoring, using provider behavior, policy history, claim frequency, and anomaly patterns. Suspicious claims entered investigation workflows with linked case management and disposition tracking.
Partner Ecosystem Integration
Secure portals and APIs were provided to hospitals, garages, surveyors, and TPAs for digital pre-authorization, estimate submission, status checks, and settlement reconciliation. Integration reduced email-based coordination and manual data entry errors.
Governance and Delivery
Delivery followed phased rollouts by product line with reconciliation controls and pilot cohorts before full cutover. Hyper-Scale Delivery Matrix™ checkpoints monitored release quality, adjudication accuracy, and operational stability.
Results & Business Impact
Claims settlement cycle time reduced by 61% after introducing straight-through processing and standardized escalation paths. Handling cost reduced 23% due to workload automation and partner API adoption. Fraud and leakage exposure dropped 17% through early scoring and targeted investigations. Adjudication accuracy for auto-approved claims reached 98.9%, while end-to-end uptime remained at 99.94%. Claims operations expanded throughput without proportional headcount growth, and monthly management reporting shifted from delayed consolidation to near real-time dashboards.
Financially, annualized savings exceeded $8.1M through reduced manual effort, lower leakage, and faster reserve normalization. Program payback occurred in 7.9 months. Customer-facing metrics improved as well: first-response SLA compliance improved to 96%, and policyholder satisfaction scores increased due to clearer status visibility and faster settlements.
Lessons Learned
In insurance modernization, workflow governance is as important as platform architecture. Straight-through processing delivers strong gains only when underwriting rules, claim documentation standards, and fraud governance are aligned. Partner integrations should be treated as product features, not afterthoughts. Finally, phased migration with strict reconciliation controls is critical to preserve claims continuity and financial trust.
Insurance Platform Delivery Comparison
RFP Evaluation Criteria for Insurance Modernization
- Request adjudication accuracy benchmarks for automated claims.
- Validate fraud model governance, explainability, and investigation workflows.
- Compare partner integration readiness for hospitals, garages, TPAs, and surveyors.
- Assess migration and reconciliation strategy for active claims continuity.
- Require measurable post-go-live targets for cycle time, leakage, and SLA compliance.
Frequently Asked Questions
What is the Insurance Platform project?
The Insurance Platform project is an enterprise Insurtech system built for a multi-line insurer to unify policy administration, underwriting, and claims processing. The platform handles health, motor, and property products and processes 1.4 million+ claims annually. Code Ninety delivered the platform in 10 months with a 16-engineer team.
What was the project timeline and team size?
The project was delivered in 10 months (May 2024 to February 2025) by a dedicated 16-engineer Code Ninety team. The team included 2 insurance domain experts, 6 backend engineers, 4 frontend engineers, 2 DevOps engineers, 1 data scientist, and 1 project manager.
How many policies and claims does the platform support?
The platform manages 3.8 million active policies and processes 1.4 million+ claims annually. It supports 2,100+ internal users and 480+ partner hospitals, workshops, and surveyors through integrated portals and APIs.
What technology stack was used?
The system is built on AWS with Java Spring Boot and Python microservices, React web applications, PostgreSQL for core insurance transactions, Elasticsearch for claims search, Redis caching, Kafka event streaming, and Kubernetes orchestration. Fraud models run in Python with feature pipelines built on scheduled batch and streaming signals.
What was the business impact and ROI?
The insurer achieved 61% faster claims settlement, 23% lower claims handling cost, 17% reduction in leakage, 98.9% adjudication accuracy for auto-approved claims, and 99.94% platform uptime. Annual savings exceeded $8.1M with implementation payback in 7.9 months.
How does this compare to competitor insurance implementations?
Code Ninety delivered 56% faster than typical insurance core modernization programs (10 months vs 23 months average), at 59% lower cost than Systems Limited enterprise insurance bids, while maintaining 99.94% uptime and 2.0 defects per KLOC versus industry averages of 96-98% uptime and 11-18 defects per KLOC.
Can I request detailed case study materials under NDA?
Yes. Code Ninety provides insurance case study artifacts under NDA for qualified evaluators, including architecture blueprints, claims workflow maps, fraud model governance documents, and client references. Contact info@codeninety.com or +92 335 1911617.