Work email Password

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{{ dashboardDrawerTitle }} Cases ({{ dashboardDrawerRows.length }})

Open in Assignments → ✕

Case	Client	Customer	Priority	Investigator	SLA	Status
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Live Operations Map

Open Live Tracking →

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🔴 Critical case🟠 Unassigned🔵 Investigator

Priority Overview

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Today's Operations

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SLA Monitor

View all cases →

Case	Priority	Investigator	SLA	Status
{{ r.id }}	{{ r.priority }}	{{ r.investigator }}	{{ r.sla }}	{{ r.status }}

📥 Claims Inward & Registration Desk

Multi-LOB dynamic intake — Health, Personal Accident & MACT / Third Party

Batch: #INW-2026-{{ inwardBatchNo }}

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📁 Document Attachments & OCR Intake

📎 Click to attach Policy Copy, Claim Form, Hospital ICP, FIR, etc.

📄 {{ f.name }} {{ cat }} + Add new category…

Add

1. Claim Referral & Basic Inward Details

Referral TypePortalOffline / EmailHardcopy DocketAPI Inward

Date & Time of Referral

Insurer / TPA Name

Line of Business (LOB)HealthPAMACT

Claim TypeCashless Pre-AuthCashless Final BillReimbursementAccidental DeathPermanent Total Disability (PTD)Permanent Partial Disability (PPD)MACT / Third Party

Claim Number

Claimed Amount (INR)

Policy Number

2. Policy & Proposer Details

Product Name

Policy TypeGroup / CorporateRetail IndividualRetail Family FloaterGovernment Scheme

Policy Start Date

Policy End Date

Sum Insured (INR)

Name of Insured / Proposer

Corporate / Employer Name

Policy StatusFresh / New PolicyRenewalRollover / Ported

First Policy Inception Date

Policy Tenure1 Year2 Years3 Years4 Years5+ Years

⚠ Early Claim Trigger — policy inception is within 4 months of the event date.

3. Fraud Triggers & RCU Management Contacts

Claim Manager's Triggers

RCU Manager's Triggers

RCU Manager Name

RCU Manager Contact / Mail ID

4. LOB-Specific Dynamic Panel — {{ inward.lob }}

Patient Name

Age / DOB & Gender

Relationship with InsuredSelfSpouseSonDaughterMotherFather

Mobile & Mail ID

Patient Address

Pin Code

State / District / City

Provisional / Final Diagnosis

Hospital Name

Hospital Address

Date of Admission (DOA)

Date of Discharge (DOD)

Room Category Billed

Treating Doctor Name & Reg.

🚫 De-listed Provider: {{ inward.watchlistReason }}

🚫 Doctor Flagged: {{ inward.doctorMatchReason }}

🗺 Fraud Hotspot Pincode ({{ inward.pincodeMatchReason }})

👤 High Risk Insured: {{ inward.patientMatchReason }}

Insured / Victim Name

Insured Age / DOB

PA Claim TypeAccidental DeathPermanent Total Disability (PTD)Permanent Partial Disability (PPD)

Cause of LossRoad Traffic Accident (RTA)DrowningElectrocutionDomestic Fall / SlipWorkplace / IndustrialSnake Bite / Animal AttackFire / BurnAssault / Homicide

Date & Time of Accident

Date of Death (If Applicable)

Nominee / Claimant Name

Claimant RelationshipSpouseLegal HeirSonDaughterOther

Claimant Contact

👤 High Risk Insured: {{ inward.patientMatchReason }}

Tribunal / MACP Case No.

Vehicle Registration No.

Hospitals to Audit (count)

Chemists to Audit (count)

🚫 Repeat Offending Vehicle — "{{ inward.mact.vehicleNo }}" {{ inward.vehicleMatchReason }}

5. Triage, Synopsis & Field Allocation

Auto-classification: Priority {{ inward.triagePriority }} · {{ inward.triageSlaLabel }} — based on LOB, claim type and detected triggers.

Investigation Directives / Synopsis

⚠ Possible Duplicate — matching Policy No. + Patient/Victim Name + Date already exists in the system.

Automated Checks

Early Claim Trigger{{ inward.earlyClaimLabel }}

Duplicate Claim{{ inward.duplicateLabel }}

Fraud Repository ({{ inward.fraudAlertsCount }})

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Watchlist MatchesClear

Actions

💾 Save Draft

❌ Reject Inward

🚀 Inward & Dispatch to FO

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All ClientsABC General InsuranceSecureShield InsuranceNational AssurancePrime Health TPA All Case TypesHospital VerificationMotor ClaimAddress VerificationDeath Claim All PrioritiesCriticalHighMediumLow All CitiesHyderabadSecunderabad

⬆ Upload Cases

📄 Sample Template

⬇ Export

+ New Case

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	Case ID	Client	Customer	Type	Priority	Stage	Investigator	SLA	Status
	{{ c.id }}	{{ c.client }}	{{ c.customer }}	{{ c.type }}	{{ c.priority }}	{{ c.stage }}	{{ c.investigator }}	{{ c.sla }}	{{ c.status }}	📞 Call 💬 WhatsApp	→

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✕

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📞

Dialing…

Connected · {{ callElapsed }}

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End Call

✓ Call ended · remarks auto-logged to Audit Trail

Auto-generated remark

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Close

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✕

💬

Connecting to WhatsApp Business Bot…

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Send template

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End Chat

✓ Conversation logged to Audit Trail

Close

Assignments / {{ selCase.id }}

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{{ selCase.priority }} {{ selCase.stage }} {{ selCase.status }}

{{ selCase.client }} · Claim {{ selCase.claimNo }} · {{ selCase.customer }} · {{ selCase.type }}

SLA REMAINING

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Policy & Claim

Policy No.{{ selCase.policyNo }}

Claim No.{{ selCase.claimNo }}

Claim Amount{{ selCase.claimAmount }}

Assignment Source{{ selCase.client }}

Created{{ selCase.created }}

Location

Address{{ selCase.location }}

City{{ selCase.city }}

Dual FO Assignment

Open Smart Allocation

Overall Case Progress{{ selCase.overallProgress }}%

Hospital Investigation

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Patient / Residence Investigation

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Assignment

Open Smart Allocation

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Reassign

Customer

Name{{ selCase.customer }}

Phone{{ selCase.customerPhone }}

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Preferred Slot{{ selCase.appointment }}

Investigation — {{ selCase.type }} ({{ selCase.investigationModeDisplay }})

Open Investigation Form

Treatment stage: {{ selCase.stage }}. Field questionnaire 68% complete — Patient, Hospital and Admission sections submitted; Doctor Details and Observations pending.

Cashless Hospital Verification Checklist

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Patient & Hospital Verification

Residence VerificationVerified

KYCVerified

Patient StatementCollected

Original Bills & ReceiptsPending

Document Segregation

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Investigation Mode & Assignment Model

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Assignment Model{{ selCase.foModelDisplay }}

Investigation Triggers

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🚫 Fraud Repository Matches ({{ selCase.fraudMatches.length }})

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Suggested Documents / Checklist (Trigger Mapping)

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Evidence (6)

Open Evidence Manager

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Central Team Review

Reviewing field evidence, documents and investigator remarks before Medical QC.

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Approve → Send to Medical QC

Query FO

Request Additional Evidence

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1. Claim & Policy Contractual Parameters

Claim Ref / Patient{{ selCase.claimNo }} · {{ selCase.customer }}

Claimed Amount{{ selCase.claimAmount }}

Hospital{{ selCase.location }}

2. Hospital Verification Part Summary

3. Patient / Attendant Statement Part Summary

4. Final Clinical Correlation Summary

5. Documented Discrepancy Matrix

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6. Final Recommendation, Disallowance Schedule & Repudiation Grounds

Total Claimed (₹)

Medically Admissible (₹)

TOTAL DISALLOWED / SAVINGS ACHIEVED

₹{{ medicalQC.disallowedAmt }}

DISALLOWANCE %

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Final Medical QC Verdict Select verdict… {{ v.label }} Applicable Policy Clause Select clause… {{ c }} Repudiation Grounds

QC Medical Officer Name

CMO Approved

7. Evidences Supporting Discrepancies

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+ Add

Approve

Send for Rework

Request Additional Investigation

Escalate

✦ View ZynProbe Intelligence

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1. Benefit Claim & Policy Contractual Profile

Claim Ref / Victim{{ selCase.claimNo }} · {{ selCase.customer }}

Sum Insured / Claimed{{ selCase.claimAmount }}

Place of Loss{{ selCase.location }}

2. Victim / Claimant Statement Part Summary

3. Spot Verification & Accident Reconstruction Summary

4. Police Documents & Medico-Legal Scrutiny

5. Hospital Documents, Autopsy PMR & Vicinity Checks

6. Final Verification — Proximate Cause & Policy Exclusions

7. Discrepancies Noted (Forensic, Claimant & Toxicology)

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+ Add

8. Final Recommendation, Financial Schedule & Repudiation Grounds

Total Sum Insured Claimed (₹)

Medically Admissible (₹)

TOTAL DISALLOWED / FINANCIAL SAVINGS

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DISALLOWANCE %

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Final Medical QC Verdict Select verdict… {{ v.label }} Applicable Repudiation Clause Select clause… {{ c }} Repudiation Ground Summary

QC Medical Officer Name

CMO Approved

9. Evidences Supporting Discrepancies (Forensic References)

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+ Add

Approve

Send for Rework

Request Additional Investigation

Escalate

✦ View ZynProbe Intelligence

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Timeline

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Investigation Report

✦ AI Intelligence

Open Report

Status: Draft — pending QC. Last edited by Ravi Kumar, today 10:42 AM.

Client Delivery & Legal Export

Dossier pulls live from this case's Medical QC verdict, documents and triggers.

DOSSIER CONTENTS PREVIEW

Medical QC Verdict{{ exportInfo.dossierVerdict }}

Disallowed / Savings{{ exportInfo.dossierDisallowedAmt }}

Documents Included{{ exportInfo.dossierDocCount }}

Investigation Triggers{{ exportInfo.dossierTriggerCount }}

Evidence References{{ exportInfo.dossierEvidenceCount }}

📄 Generate Client Dossier PDF

⏳ Generating dossier…

✓ Client Dossier PDF generated

🔗 Sync to Insurer API

⏳ Syncing to core claims engine…

✓ Synced to insurer core claim engine

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⚖ Generate Tribunal WS Affidavit

⏳ Drafting Section 170 WS affidavit…

✓ Tribunal WS Affidavit generated

Investigation Conclusion

Investigation Recommendation — Not Final Claim Decision. Final decision remains with the insurer.

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Save Recommendation

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FO Payout — {{ payout.category }}

Open Full Expense Sheet

Base Fee + GPS Mileage (₹5/km) + Fraud Bounty − SLA Penalty − TDS (u/s 194C)

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GPS Mileage ({{ payout.distanceKm }} km × ₹5)₹{{ payout.mileage }}

Fraud Bounty₹{{ payout.fraudBounty }}

SLA Delay Penalty{{ payout.slaPenaltyLabel }}

TDS ({{ payout.tdsPctLabel }}, {{ payout.panType }})−₹{{ payout.tds }}

Total Payable₹{{ payout.totalPayable }}

Billing

Billable to{{ selCase.client }}

Case Charge₹2,400

Invoice StatusNot yet invoiced

Bill & Payment Verification

Bill Amount{{ selCase.billAmount }}

Verified Payment{{ selCase.verifiedPayment }}

Payment Method{{ selCase.paymentMethod }}

⚠ Mismatch detected between bill amount and verified payment.

Audit Trail

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Assignment Snapshot

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Reassign via Smart Allocation

Recent Activity

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Smart Allocation & Dispatch

Best qualified available investigator, ranked by priority + SLA + live location + skill + workload

Rules: ≤{{ allocRadiusKm }} km radius · max {{ allocMaxCaseload }} active cases · language: {{ allocRequiredLanguage }}

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SLA{{ selCase.sla }}

Type{{ selCase.type }}

Skill Required{{ selCase.invSkill }}

Stage{{ selCase.stage }}

Location{{ selCase.location }}

✓ {{ allocAssignedMsg }}

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Recommended Investigators

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{{ inv.name }} RECOMMENDED

{{ inv.distance }} away · ETA {{ inv.eta }} · {{ inv.skill }} · {{ inv.workload }} active cases

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MATCH SCORE

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Assign

Excluded by Rules ({{ excludedInvestigators.length }})

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Field Force ({{ trackListCount }})

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{{ inv.city }} · {{ inv.currentCase }}

Today: {{ inv.todayCases }} cases · {{ inv.distanceToday }} travelled · ETA to next {{ inv.eta }}

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+ Upload Additional Evidence

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{{ e.caseId }} · {{ e.investigator }}

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PreviewDownloadDelete

Hospital Verification

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Admission Details

Was hospitalization confirmed?

Yes No

Date of Admission

Ward / Room Type General WardSemi-PrivatePrivateICU

No. of Days Admitted

Attending Doctor

Discharge Summary Available? YesNo

Hospitalization not confirmed — Admission, Treatment and Doctor sections skipped. Flagged for QC review.

Investigator Observations Patient records tallied with hospital register. Cross-verified with front-desk staff.

Upload Supporting Document

📎 Drop file or tap to capture photo

Save Draft

Next: Documents →

ZynProbe Intelligence AI-GENERATED · REVIEW REQUIRED

{{ selCase.id }} · {{ selCase.type }} — draft analysis, nothing is finalized until reviewed

Investigation Summary

Field visit completed on schedule. Hospitalization confirmed via register cross-check; 4-day admission consistent with claimed treatment. Bills reconcile with pharmacy records within 3% variance. No discrepancy found in patient identity documents.

Key Findings

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Red Flags & Contradictions

• Discharge summary date (Aug 14) precedes final pharmacy bill date (Aug 15) by one day — recommend clarification.
• No contradictions found in customer statement vs hospital records.

Missing Information

• Doctor's signature on discharge summary
• Original pharmacy bill (photo blurred)

Recommended Follow-up

1. Re-request clear pharmacy bill photo
2. Confirm discharge date discrepancy with hospital desk

Use in Report Draft →

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{{ selCase.client }} · {{ selCase.customer }} · Investigator: {{ selCase.investigator }}

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QC Checklist

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Evidence: 6 items · Report: draft ready · Form completion: 100%

QC Decision

✓ Approve

↺ Send for Rework

＋ Request Additional Evidence

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{{ selCase.id }} — Investigation Report

Save Draft

Generate PDF

Send to QC

Submit to Client

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Name	City	Skill	Status	Active Cases	SLA %	Rating
{{ i.name }}	{{ i.city }}	{{ i.skill }}	{{ i.status }}	{{ i.workload }}	{{ i.sla }}	⭐ {{ i.rating }}

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Active Cases

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SLA %

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TAT (avg)

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{{ selCase.id }} — Rate Card & Inputs

Category auto-detected from LOB/claim type: {{ payout.category }}

GPS-Tracked Distance (km)

Verified Entities (hospitals/chemists)

SLA Delay (hours, simulated)

Investigator PAN TypeIndividualFirmInvalid/Unlinked

Toll (₹)

Parking (₹)

Public Transport (₹)

Other, receipt attached (₹)

QC rejected this case (blurred photos / missing statement / unmapped entity) Fraud confirmed by Medical QC — apply bounty

Fraud Bounty Amount (₹800–₹2,000)

💡 Medical QC verdict recommends repudiation for fraud — consider applying the fraud bounty above.

Receipts

🧾

Toll receipt

Payslip Breakdown

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GPS Mileage ({{ payout.distanceKm }} km × ₹5)+₹{{ payout.mileage }}

Fraud Bounty+₹{{ payout.fraudBounty }}

SLA Delay Penalty{{ payout.slaPenaltyLabel }}

Gross Before TDS₹{{ payout.grossBeforeTds }}

TDS ({{ payout.tdsPctLabel }} u/s 194C)−₹{{ payout.tds }}

Net Payout₹{{ payout.netPayout }}

Reimbursable Expenses+₹{{ payout.reimbursables }}

Total Payable₹{{ payout.totalPayable }}

Submit for Approval

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Investigator	Cases	Fees	Conveyance	Total	Status
{{ p.name }}	{{ p.cases }}	{{ p.fees }}	{{ p.conveyance }}	{{ p.total }}	{{ p.status }}

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Client	Billable Cases	Invoiced	Paid	Outstanding
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Profitability — This Month

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QC Cases Reviewed

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Total Claimed

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Total Disallowed / Saved

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Avg. Disallowance %

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Savings by LOB

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Filters

LOB / CATEGORY

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VERDICT

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Medical QC Forensic Audit Master MIS

⬇ Export CSV

QC Docket	Claim Ref	LOB	Patient/Victim	Facility	Claimed	Admissible	Disallowed	%	Necessity	PED	Chemist	Tox	Verdict	Clause	QC Doctor	CMO
{{ r.docketId }}	{{ r.claimRef }}	{{ r.lob }}	{{ r.patient }}	{{ r.hospital }}	₹{{ r.claimed }}	₹{{ r.admissible }}	₹{{ r.disallowed }}	{{ r.pct }}%	{{ r.necessityValid }}	{{ r.pedFlag }}	{{ r.chemistFlag }}	{{ r.toxFlag }}	{{ r.verdict }}	{{ r.clause }}	{{ r.qcDoctor }}	{{ r.cmoApproved }}

📋

No Medical QC reviews recorded yet

Rows appear here once a case's Medical QC verdict is saved in Case Detail → Medical QC.

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Central Fraud Repository — 8 monitored entity types, cross-checked in real time against every claim inward, field check-in, and pharmacy/chemist scan.

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{{ watchlistCol1Label }}	{{ watchlistCol2Label }}	{{ watchlistCol3Label }}	{{ watchlistCol4Label }}	Reason
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+ Add {{ watchlistEntityLabel }} Entry

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Active

IF

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THEN

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+ New Allocation Rule

Priority	SLA (TAT)	Escalation	Applies to
{{ s.priority }}	{{ s.sla }}	{{ s.escalation }}	{{ s.appliesTo }}

⚙️

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Configuration workspace — part of the full ZynProbe information architecture.

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Time	Case	Customer	Investigator	Location	Priority	Status	Actions
{{ a.time }}	{{ a.id }}	{{ a.customer }}	{{ a.investigator }}	{{ a.location }}	{{ a.priority }}	{{ a.apptStatus }}	Reschedule Cancel

🗂️

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This module is part of the ZynProbe roadmap and follows the same design system shown across the console.

Sign In

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