Compliance-grade claims automation across India operations.

The challenge

India-region medical claims arrived from a long tail of hospitals and TPAs in inconsistent formats, and the in-house RCM team was absorbing a denial rate that kept climbing as policy detail multiplied. Every adjudication had to be defensible against a HIPAA-grade audit, which made aggressive automation feel risky.

How we approached it

Ajuni connected Vaidya to the J&J claims gateway and the policy-rules engine, with Veer attaching a signed reasoning chain to every adjudication. The deployment ran on Azure India South under J&J's existing tenant, with PHI never leaving the regulated boundary and every model call cached and replayable for audit.

Outcomes in production

• 41% denial-rate reduction inside the first 90 days
• Vaidya cleared 84% of claims without human review
• Reasoning chain attached to every adjudication
• Audit posture cleared by global compliance team
• 12 weeks from kickoff to production traffic

Stack & guardrails

Timeline

1. Week 0–2

   PHI boundary mapping

   Claims flow mapped end to end; compliance signed off on data path.

2. Week 3–5

   Policy-rules training

   Vaidya tuned against six months of historical adjudication outcomes.

3. Week 6–9

   Shadow adjudication

   Agent ran parallel to human reviewers; outputs compared daily.

4. Week 10–12

   Production rollout

   Live claims auto-adjudicated; global compliance review cleared launch.