Claims Management
Health claims & pre-authorization with up to 97.5% automation.
JClaims is the platform that fully digitalizes the health claims and pre-authorization journey and reaches the industry’s highest automation rates. Web and mobile claim entry, HL7/FHIR hospital integration, SGK/TSS Medula connectivity and pharmacy authorization come together in one hub. Supporting ICD, CPT, DRG, SUT and HUV standards, it executes policy and network rules in real time — freeing resources and reducing leakage with 84–97.5% automation depending on the policy.
84–97.5% claims automation depending on policy
Integrated hospital authorization via HL7 / FHIR
Two-way SGK / TSS Medula integration
Real-time operations dashboards and leakage control
Modules & Components
Modules within the family — working together or standalone.
JClaims for Web
Web-based claim entry and policy validation supporting ICD, CPT, DRG, SUT and HUV coding standards.
JClaims for Integrated Providers
Automated claim submission and real-time status updates from hospital systems via HL7 / FHIR.
JClaims API's & SDK for Mobile
Claims APIs and SDKs for mobile apps.
JLink for Medula
Two-way integration with the SGK / TSS Medula system.
JPharmacy for Claims
Pharmacy authorization and drug claims management.
JRules for Policy Execution
A robot executing policy coverage and exclusion rules in claims.
JRules for Networks
Management of provider network and pricing rules.
JPolicy Catalog Manager
Coverage packages and policy-clause catalog management.
JMed Reference Data
Central health reference data including ICD, DRG, ATC, drug and procedure codes.
JBig for Health Claims
Analytics and reporting data warehouse for health claims.
JDashboards for Healthcare
Real-time dashboards for healthcare operations.
JNetwork Management
Provider network and pricing management.
An insurer running one of Türkiye’s largest complementary-health portfolios
Health ClaimsChallenge
Rising claim volumes outgrew manual review capacity; authorization times lengthened and leakage costs grew.
Solution
With JClaims, provider authorizations were automated via HL7/FHIR and policy and network rules were executed in real time through JRules.
Ready to transform your insurance operations?
Meet our team and see JSure applied to your own processes.
Get in Touch