Qubiclo is built specifically for health insurance claims — not adapted from a generic workflow tool. Every feature exists to help your team process claims faster, catch more fraud, and stay compliant with less effort.
Rules run on every claim. Decisions in seconds.
The adjudication engine applies your benefit rules to every claim the moment it arrives. No queue. No waiting for a reviewer to open it. Straightforward claims — the ones that clearly meet your criteria — are approved and closed automatically.
Seven ways to catch fraud. All running before you pay.
Qubiclo runs a multi-layer fraud analysis on every claim before a decision is produced. The detectors don't replace your reviewers — they find the cases that need them, and surface exactly why each case was flagged.
Claims arrive as PDFs and spreadsheets. We read them.
Not every claim arrives as a structured API call. Qubiclo handles the messy reality of claims intake — PDF invoices, Excel batches, scanned forms — and converts them into structured claim records that the adjudication engine can evaluate.
Every claim checked against the contract you signed.
Your provider contracts set out exactly what each provider is allowed to charge. Qubiclo enforces those contracts automatically on every claim — so a billing error or deliberate overcharge is caught before the payment goes out.
The right person sees the right claim at the right time.
Claims that need a human reviewer don't sit in a shared inbox. Qubiclo routes them through a configurable approval chain — with role assignments, SLA tracking, and full visibility into where every claim is in the process.
Upload your policy documents. We'll enforce them.
Benefit rules are easy to configure. But insurance policies contain nuance — coverage conditions, exceptions, exclusion criteria that can't always be reduced to a simple rule. Qubiclo's policy reasoning layer lets you upload your policy documents and have the system reason over them when adjudicating claims.
Every action. Every outcome. Every time.
Qubiclo maintains a complete, immutable record of everything that happens to every claim. When a regulator asks what happened and why, your team can produce the full history in minutes — not hours.
What's happening with your claims. In real time.
Your claims data is a window into your business — fraud trends, provider behaviour, processing efficiency, payout risks. Qubiclo surfaces the information that matters, and lets you export it in the format you need.
Fits into whatever you're already running.
Qubiclo is API-first. Every operation in the platform is available via the REST API — so you can build claims submission directly into your existing workflows, and receive real-time notifications when a claim's status changes.
Qubiclo vs manual
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