Claims adjudication built to protect your loss ratio.
Every valid claim clears fast and every questionable one is held before money leaves, so providers are paid, members are served, and your loss ratio holds, without growing the review team.
Fast where it's earned, careful where it's needed.
Leakage from inconsistent calls, gone
Every claim is assessed against your benefit limits, exclusions, tariffs and eligibility the same way every time, so margin stops draining through missed limits and judgement calls that vary by assessor.
A growing book, the same team
Clean claims clear without manual review, so you take on more volume without more headcount, and providers are paid faster.
A human on every exception
Ajé will not deny a claim automatically beyond a strict false-denial threshold. Exceptions go to people, with the full context attached.
Built for the local market
NHIA-aware tariff structures and an NDPA 2023 aligned data posture in Nigeria today, with the same rigour in every market we enter.
The loss ratio is decided one claim at a time.
The loss ratio, the share of premium paid back out in claims, is not moved by a quarterly report. It is moved by thousands of individual decisions, each made while the claim is still in front of you. Manual vetting puts clean claims in the same queue as the ones that need scrutiny, and cost follows delay.
Automated adjudication changes the economics of that queue. Valid spend clears quickly, so providers are paid and members are served. Questionable spend is held back and examined before money leaves. Your reviewers stop spending their day rubber-stamping the obvious and start spending it on the claims where their judgement is worth the most.
Ajé is live in Nigeria and built to take the same adjudication discipline to health insurers across Africa, one market’s depth at a time.
Decide at the point of the claim, not in a report after the money has left.
Claims adjudication, answered.
What is automated claims adjudication?
Does the platform ever deny a claim automatically?
Is Ajé built for the Nigerian HMO market?
How does adjudication protect the loss ratio?
See adjudication against your own book.
We run a working session with your operations team, walking through adjudication on the workflows you handle every day.