🔁 For TPAs

AI-Powered Operations
for Third Party Administrators

Process claims for multiple insurers simultaneously AI routing, automated adjudication, and T+20 provider settlement without growing your operations headcount.

Request Demo → See How It Works
🔄 Multi-Insurer Routing 🤖 AI Adjudication ✅ NHCX Connected
Zealthix · TPA Operations
// Claim routing across insurer portfolio → zyncflo.route("CLM-TPA-19934") insurer_id: New India Assurance policy_no: NIA-GRP-2025-41 channel: NHCX gateway routed: insurer queue ✓   // AI adjudication against insurer rules → zudy.adjudicate({ insurer: "NIA" }) benefit_set: NIA Platinum rules applied ✓ fraud_score: 0.05 low approved: ₹28,400   → zudy.settle() payment: NEFT provider account elapsed: 3.8s
50+Insurer networks supported
97%Claims auto-adjudicated
T+20Provider settlement cycle
ZeroManual claim routing effort
What We Solve

Scale your TPA operations
without scaling headcount

🔄

Multi-Insurer Claim Routing

ZyncFlo routes incoming claims to the correct insurer queue automatically format transformation, eligibility pre-check, and NHCX submission handled without manual intervention regardless of insurer count.

🤖

Per-Insurer AI Adjudication

Zudy maintains separate benefit rule sets for each insurer you service. Claims adjudicated against the exact policy configuration for that insurer including copay rules, sub-limits, and exclusion lists.

⚡

OPD Plan Administration

Zive configures OPD benefit plans on behalf of each insurer from their policy documents. Multiple plan variants and provider networks managed simultaneously no per-insurer IT effort.

🛡️

Cross-Insurer Fraud Detection

AI identifies members filing identical claims across multiple insurers, duplicate provider billing, and coordinated fraud rings patterns that single-insurer systems can't see.

💳

Automated Provider Settlement

Settlement batches generated per insurer with correct payment allocation. Providers receive a single consolidated payment advice reconciliation automated on both sides.

📊

TPA Performance Dashboard

Real-time visibility into claim volumes, adjudication SLAs, settlement status, and fraud flag rates across all insurer portfolios the operational command centre your team actually needs.

How It Works

One platform,
every insurer you service

Zealthix becomes the unified operating layer for your TPA all insurer portfolios managed from one platform, all claims processed by AI.

1
Connect Your Insurer Portfolio

Each insurer's policy rules, benefit sets, and provider networks loaded into Zealthix. One integration from your existing HMS/claims system connects all of them.

2
Claims Auto-Routed

Incoming claims matched to the correct insurer policy automatically. No manual sorting, no routing errors ZyncFlo handles multi-payer claim distribution end-to-end.

3
AI Adjudicates Per-Insurer Rules

Zudy applies the specific benefit rules for each insurer. Same claim engine, insurer-specific configuration consistent accuracy across every portfolio you manage.

4
Settlement & Reporting Automated

Providers settled T+20. Per-insurer settlement reports generated automatically. Your team focuses on exceptions and client relationships not claim processing.

TPA operations dashboard
Impact

More claims, fewer people,
happier insurers

97%
Claims auto-adjudicated across all insurer portfolios
3x
More claim volume processed per operations staff member
T+20
Provider settlement vs T+45 industry average for TPA processing

Process more claims for
more insurers automatically

See how Zealthix handles multi-insurer routing and per-insurer adjudication in a live demo tailored to your portfolio size.

Book a Demo →