Settle claims faster. Stop leakage before it’s paid.
Avalon is the AI-powered claims engine for insurers. It checks every bill against tariff and policy, catches duplicates, coordination-of-benefits overlaps and abuse before payment, and gives leadership a live view of turnaround, loss ratio and leakage by hospital.
Built for health insurers
- Cashless and reimbursement claims
- OPD bulk
- Fraud and leakage control
- Real-time analytics
The problems insurers live with, in their own words.
We asked senior insurance professionals what concerns them most. Their answers, quoted exactly, fell into four themes.
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Delays and turnaround time
- “Delays in payments and no visibility at every stage.”
- “Delay in claim processing due to manual processing steps.”
- “TAT issues.”
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Capacity and resource strain
- “Processing of OPD bulk requiring extreme resource consumption.”
- “Addressing queries on claim status, coverage and deductions.”
- “Trained resources shortages.”
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Leakage, fraud and overbilling
- “Wastages due to human errors, frauds, abuses.”
- “Excess pharmacy vs actual treatment on ticket.”
- “Bill upcoding / segmentation.”
- “Duplication of invoices/bill.”
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Assessment errors and rework
- “Incomplete/incorrect documentation.”
- “Wrong assessment of COB.”
- “Calculation error / missed subrogation.”
- “Rework due to inaccuracies / plugging leakage.”
Many symptoms. Four root causes.
- Claims leakage and missed subrogation
- Process efficiency and turnaround time
- Automation and digitisation
- Real-time data and analytics, from a single claim to the whole book
The cost of standing still
Left manual, leakage compounds silently across the book, every single year. Enter your own figures to see the scale.
Where the money goes
- Above-tariff and fraudulent billing
- Duplicate invoices
- Coordination-of-benefits overpayment
- Missed subrogation
- Medically unnecessary services
- Upcoded and unbundled bills
- Pharmacy in excess of the treatment given
Annual claims spend PKR 8 billion
Lost to leakage, every year
~PKR 440 million
An illustrative estimate from the figures above. The leakage rate is an assumption; set it to what you see in your own book.
One engine for every claim, from intake to insight.
Avalon is the AI-powered claims engine for insurers. It does the repetitive checking at scale, flags anything that needs a closer look with a reason in plain language, and leaves the decision with your people.
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Smart onboarding and intake
Clients, members and claims enter through one digital funnel, whichever channel they arrive from. Handwritten documents are read automatically, and only unclear fields go to a person.
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Bill and tariff scrutiny
Every bill line is checked against your tariffs and the member's policy automatically, and variances are deducted before approval.
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Fraud and COB detection
Duplicate invoices, coordination-of-benefits overlaps, missed subrogation and abuse are caught before payment, not after.
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OPD bulk settlement
Bulk outpatient claims are settled against policy and tariff, without the manual effort that ties up your teams.
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Unified ticketing and CRM
Member history, policies, claim status and every conversation in one view, so queries on status, coverage and deductions are answered quickly, whatever the channel.
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Real-time analytics
Live dashboards on turnaround, loss ratio and leakage by hospital, from a single claim to the whole book.
What it looks like on real claims
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A cashless pre-authorisation, corrected before approval
A hospital requests pre-authorisation for a coronary stent at PKR 1,000,000. Avalon finds a PKR 75,000 variance against tariff and applies the deduction before approval. The claim then moves through eligibility, medical review, adjudication and payment, with every action, owner and turnaround time on record.
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A duplicate and a shared liability, stopped before settlement
A bill is resubmitted under a different spelling, and Avalon matches it to the original. On another claim, a second insurer carries part of the liability, and Avalon flags it before payment.
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Leakage traced to the hospitals behind it
Hospitals are ranked by above-tariff variance, duplicate rate and upcoding, and the year's claims spend is broken down into what was paid correctly and what went to above-tariff billing, duplicates, recoverable COB and fraud.
What changes for leadership
Each root cause gets a direct answer, and each answer shows up where it matters: in the loss ratio, in turnaround times and in the trust of your clients and hospitals.
- Less leakage
- Above-tariff billing, duplicate invoices, COB overpayment and missed subrogation are stopped before the money leaves, not found in an audit months later.
- Faster turnaround
- Claims move from intake to payment without manual hand-offs, and the turnaround of every stage is measured and visible.
- More from your team
- OPD bulk, document reading and routine checks run automatically, so trained staff spend their time on the claims that need judgement.
- Decisions on live data
- Loss ratio, turnaround and leakage by hospital, from a single claim to the whole book, whenever you need them.
Your data never leaves your walls.
Claims data is among the most sensitive information an insurer holds. Avalon is built so that it stays under your control.
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On your premises
Avalon runs inside your own data centre. Claims data stays on your infrastructure, governed by your network and your policies.
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Isolated by design
A deployment dedicated to you alone, with no shared databases, no connection to other insurers and no outbound path for your data.
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Encrypted and access-controlled
Data is encrypted at rest and in transit. Access follows each person's role, and a permanent audit trail records who did what, and when.
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Independently assured
Built to recognised security standards, with third-party security audits and your own right to audit.
Live in roughly six months
From signing to a live system, in four stages.
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Months 1–2
Configuration
Avalon is configured around your framework: your products, tariffs, policies and approval rules.
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Months 2–4
Training and testing
Your teams are trained on the system, and it is tested before anything goes live.
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Months 4–6
Go-live
Avalon is implemented across your claims operation and goes live.
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Month 6 onwards
AI modules
AI modules and new capabilities are rolled out on the live system as you need them.
See Avalon on claims like yours.
Book a walkthrough with our team. We'll show you a pre-authorisation checked against tariff, a duplicate and a COB case caught before payment, and leakage traced by hospital, then talk through what deployment would involve.
Request a demo or get in touch
Tell us a little about your organisation and we'll arrange a time that suits you.
What to expect
- A conversation about your claims operation. Where time and money are being lost today.
- A live walkthrough. Tariff checks, duplicates and COB, and leakage by hospital, on claims like the ones your teams handle.
- A clear plan. What deployment involves, from configuration to go-live in roughly six months, with no obligation.
Prefer to reach us directly? Email us at hello@avalon.pk
Thank you. Your request is with our team.
We'll contact you at your email address to arrange a time.