CarePay offers a cloud‑native, API‑first platform that digitizes the full health insurance lifecycle for insurers in emerging markets, covering enrollment, eligibility checks, pre‑authorizations, claims processing, and payments. By providing modular insurance modules, AI‑driven pricing, and a member mobile app, the solution speeds product launches, cuts administrative costs, and improves transparency for both members and providers.
Funding
$57.6M raised to dateRaised to date based on public sources. This may differ from the amount the company actually raised and is based only on what is publicly available on the internet.
Founders
Product
Problem
Health insurers in emerging markets face fragmented, paper‑based processes for enrollment, eligibility verification, pre‑authorization, claims submission, and payments, leading to high administrative costs, long turnaround times, and limited access to care for members.
Solution
CarePay provides a cloud‑native, API‑first platform that digitizes the entire health insurance lifecycle—from policy creation and member enrollment to real‑time eligibility checks, automated pre‑authorizations, and fast claims processing. The platform integrates with existing payer systems and provider portals, enabling instant verification of coverage and automated payment flows that reduce claim settlement from weeks to hours. Built with modular, scalable components, CarePay lets insurers launch new product segments quickly, adjust pricing with AI‑driven algorithms, and expand across regions while maintaining ISO‑certified security and role‑based access controls. By delivering a member‑focused mobile app and provider self‑service tools, the solution improves transparency, reduces fraud and waste, and lowers overall operating costs.
Target Audience
CarePay serves health insurers, both private and public payers, operating in emerging and frontier markets who need to digitize operations, launch new product segments, and improve member and provider experiences.
Features
- End‑to‑end digital workflow covering enrollment, eligibility, pre‑authorization, claims, and payments
- API‑first integrations with core systems, BI tools, and third‑party applications; FHIR support for interoperability
- Modular core insurance modules that can be configured and scaled to launch new health segments rapidly
- AI‑powered pricing and underwriting automation for real‑time premium calculation and policy adjustments
- Instant eligibility verification and automated pre‑authorization approvals within seconds
- Claims engine with customizable business rules, authority matrices, and automated fraud detection, reducing processing time by up to 95%
- Provider portal and self‑service tools for network management, claim submission, and fast reimbursements
- Member mobile app offering real‑time benefit visibility, provider search, claim submission, and health data integration
- Cloud‑native deployment with optional local storage, ISO‑certified security, and role‑based access control
- Advanced analytics dashboard delivering real‑time insights on utilization, fraud, and cost drivers