| BIOGRAPHY

With 25 years of experience in the insurance industry and deep expertise in health insurance, Mahendra leads the commercial strategy for Perfios’ insurance vertical across the APAC region.

A seasoned business development leader in insurance technology, he focuses on health insurance product positioning, serves as a Subject Matter Expert in medical fraud, waste, and abuse (FWA) mitigation, and drives digital transformation at scale for insurers.

Renowned for his collaborative leadership and forward-thinking mindset, he continues to fuel innovation across the insurance ecosystem, delivering value-driven solutions and strengthening Perfios’ market presence throughout the region.

| TOPIC

AI-powered Health Claims Adjudication – The CEO’s Definitive Guide

| ABSTRACT

Perfios Acclaim is an AI and ML-driven platform designed to automate the end-to-end health insurance claims process. It performs intelligent data extraction, multi-layered categorization using three distinct AI/ML models, dynamic benefit mapping, and auto-adjudication. The categorization engine is continuously enhanced with up-to-date medical and health knowledge from leading global partners, ensuring accuracy and relevance. Acclaim’s FWA (Fraud, Waste, Abuse) detection engine identifies suspicious claims in real-time, improving financial control. The platform supports both STP and non-STP workflows, adapting seamlessly to diverse operational needs. It also applies machine learning to improve accuracy over time, based on live feedback and outcomes. In a recent case study, Acclaim helped improve claims processing productivity by 70% and reduced reimbursement losses by 3% through enhanced Non-Covered Item (NCI) detection and FWA triggers. Scalable, configurable, and compliant with local regulations, Acclaim empowers insurers to drive digital transformation while enhancing customer experience and operational performance.