How would you improve Digit Insurance's cashless health claims experience at network hospitals?

Introduction

Cashless hospitalisation is the most important promise in health insurance: at a network hospital, the insurer pays the hospital directly, so the family does not have to arrange lakhs of rupees in an emergency. In practice, cashless claims in India often involve long waits for pre-authorisation, last-minute queries and stressful discharge delays. IRDAI's 2024 master circular on health insurance pushed insurers to decide cashless requests within one hour and final discharge authorisation within three hours. Digit Insurance's health business shrank in FY26 while motor grew, so improving the health claims experience is both a customer and a strategic priority. This question asks how to improve Digit's cashless health claims experience.

Step 1

Clarifying Questions (5 mins)

• Which policies? Retail health policies and group health policies Digit provides to employers. Assume we focus on retail first.
• Which part of the journey? Admission, pre-authorisation, hospital stay, enhancement requests and discharge. Reimbursement claims are out of scope.
• Who handles claims? Assume a mix of in-house claims teams and a third-party administrator (TPA) for some policies.
• Goal? Faster and more predictable cashless claims, measured by time to decision and customer satisfaction, without raising claim costs through fraud or overbilling.
• Data? Assume we can see pre-authorisation timestamps, queries raised, hospital responses and final settlement amounts.

Goal: cut median discharge authorisation time well below the three-hour limit and reduce families' out-of-pocket surprises at discharge.