ClaimsIQ gives Nigerian HMOs and insurers AI-powered claims triage through WhatsApp — with a plain-English audit trail and human reviewer in the loop. Under 30 seconds per claim.
Industry estimates put health insurance fraud at 8–15% of total claims value. Most HMOs and insurers are fighting this with Excel spreadsheets, WhatsApp text, and paper printouts.
Claims staff re-enter data from WhatsApp messages by hand. No structured process. Decisions made on printed sheets. No audit trail.
OperationalClaims above the NHIA benchmark pass without challenge. Manual reviewers cannot cross-reference 800+ drug tariffs on every claim.
Financial LossA fraud probability of 73% means nothing without a reason. Reviewers ignore scores they don't understand. The AI goes unused.
Trust GapAI-assisted claims decisions require documented reasoning. WhatsApp screenshots and manual notes do not satisfy NAICOM guidelines.
Compliance RiskSection 210 mandates fast claims settlement for all Nigerian insurers. Manual turnarounds of 3–5 days are now legally non-compliant. Enforcement is active from 2026.
Legal LiabilityThe existing fraud detection platforms cost $50K+. They assume dedicated IT teams. They are built for US and European markets — not Nigerian HMOs with lean operations teams.
AccessibilityFraud. Manual delays. NAICOM risk. NIIRA liability.
Nigerian insurers are managing a serious and growing compliance and financial risk — with tools that were not built for the job.
ClaimsIQ was.
The Process
No new app. No new portal. No new training. Staff use the channel they already use every day.
Claim text or photo sent to the ClaimsIQ WhatsApp number. Same number for HMO health claims and motor damage photos.
Claude Sonnet extracts claim data, checks NHIA tariff, scores risk LOW / MEDIUM / HIGH / FRAUD FLAG in under 30 seconds.
For photo submissions — receipts, discharge letters, vehicle damage — Vision AI extracts structured data automatically.
HIGH and FRAUD FLAG claims route to a reviewer with the full AI reasoning panel. Human always in the loop. AI never decides alone.
Every decision — AI score, reviewer comment, timestamp — logged automatically. NAICOM-ready. NDPA 2023-compliant. Immutable.
A pharmacy assistant snaps a photo of a discharge letter and the attached receipts and sends them to the ClaimsIQ WhatsApp number. Vision AI extracts the line items — drug names, quantities, prices — and ClaimsIQ runs each item through the NHIA tariff check to flag over-billing, duplicate submissions, and out-of-scope services. LOW-risk claims auto-approve. HIGH and FRAUD FLAG claims land on a reviewer's queue with the full AI reasoning panel attached.
These are real screenshots from the live ClaimsIQ prototype. Not mockups. Not illustrations. The actual product.
Mixed IMAGE and TEXT claims in one queue. FRAUD FLAG auto-escalated. 28-second average processing time.
Built specifically for Nigerian HMOs and insurers. No enterprise configuration. Live in days, not months.
Staff submit claims through the WhatsApp number they already use. Text or photo. No new app. No new login. Zero adoption friction. Average submission time: under 60 seconds.
Every risk score comes with a human-readable explanation. Claude Sonnet tells your reviewer exactly what it found and why. Reviewers trust what they understand. The AI gets used.
Every claim checked against the current NHIA tariff benchmark. Overruns flagged automatically with the exact variance amount. Reviewers approve at tariff rate with one click.
AI triages. Human decides. HIGH and FRAUD FLAG claims require a mandatory reviewer comment before any decision is logged. AI never approves or rejects alone. Ever.
Vision AI reads pharmacy receipts, discharge letters, lab results, and vehicle damage photos. Extracts structured data from any image submitted via WhatsApp — no manual re-entry required.
Every decision logged with reviewer ID, timestamp, AI reasoning, and outcome. Immutable. Available for NAICOM review at any time. NDPA 2023 data handling compliant.
Section 210 settlement deadline tracked on every motor claim. Adjusters see the countdown. Zero breach risk. Automatic timestamped audit trail satisfies NAICOM documentation.
Amount vs NHIA tariff. Provider frequency. Patient frequency. Duplicate detection. Temporal anomalies. Code mismatch. Six checks on every single claim — in under 30 seconds.
Whether you manage health claims for an HMO or motor claims for a general insurer — ClaimsIQ has a solution built for your workflow.
WhatsApp-native health claims triage with NHIA tariff checking and NAICOM-ready audit trail.
Perfect for you if:
WhatsApp photo claims with NIIRA 2025 compliance tracking, AI damage zone detection, and zero deadline breaches.
Perfect for you if:
Also applicable for Microfinance Banks (Month 18+), Agriculture Insurance, and Corporate HR Benefits management.
Nigeria's health insurance sector is underpinned by the work of thousands of honest providers, diligent claims reviewers, and policyholders who trust their HMO to protect them.
Fraud at scale — estimated at 8 to 15 percent of total claims value across the sector — diverts resources from genuine patients, raises premiums, and erodes trust in an industry Nigeria needs to work.
ClaimsIQ exists to close the gap between the scale of this problem and the sophistication of the tools available to fight it. We are building AI-powered claims intelligence that works inside the channels Nigerian insurance professionals already use. WhatsApp-native. Explainable. Human-in-the-loop. Compliant.
We are not replacing the human reviewer. We are giving them what they need to make the right call — every time.
AI assists. Humans decide. Every HIGH and FRAUD FLAG claim requires a human reviewer. Always.
Every AI score comes with a plain-English reason. Reviewers understand every recommendation we make.
WhatsApp-native. NHIA-aware. NIIRA 2025 compliant. Designed for the workflows of Nigerian insurance teams — not adapted from a US or European product.
ClaimsIQ is designed to satisfy NAICOM, NHIA, NIIRA 2025, and NDPA 2023 requirements from day one.
Every AI-assisted claims decision is logged with reasoning, reviewer ID, and timestamp. Satisfies NAICOM audit documentation requirements for AI-assisted processes.
Every health claim cross-referenced against the current NHIA tariff schedule. Overruns flagged automatically. HMO reviewers approve at tariff rate with one click.
Settlement deadline tracked on every motor claim. Timestamped receipt and decision record satisfies Section 210 documentation requirements. Zero deadline breach risk.
Health data stored in Nigerian-region GCP infrastructure (africa-south1 region) only. NDPC-registered data processor. 30-day image retention policy. TLS 1.3 + AES-256 encryption. No data persisted on Meta or WhatsApp servers.
AI never makes a final claims decision. HIGH and FRAUD FLAG outcomes require mandatory human reviewer action before any decision is logged. Satisfies NDPA automated decision requirements.
All health and claims data stored exclusively in Nigerian-region GCP cloud infrastructure (africa-south1). Data never leaves the African region. GCP Cloud KMS with CMEK for key management.
ClaimsIQ operates as a data processor under NDPA 2023. NDPC registration completed prior to processing any client data. For data handling queries: privacy@claimsiq.ng
Start with a 3-month pilot. Upgrade when your volume grows. Prices shown in GBP, NGN, or USD.
£1 = ₦1,824 · £1 = $1.27 (June 2026 rates — subject to change)
Up to 2,000 claims / month
Up to 10,000 claims / month
Unlimited claims
All plans include:
Not sure which plan fits? Book a 30-minute demo and we will recommend the right tier for your claims volume. Book a Demo →
Honest answers. No corporate waffle.
No. ClaimsIQ sits alongside your existing workflow. Staff continue submitting claims via WhatsApp — which most are already doing. ClaimsIQ adds the AI triage layer on top. Your reviewers continue making decisions. They just have better information to make them with.
Minimal. Staff submit claims to a WhatsApp number — the same way many are already communicating. No new app. No portal login. No new software to learn. We provide a one-page submission guide. Most teams are fully live within 48 hours of onboarding.
All claims data is stored in GCP Nigeria-region infrastructure (africa-south1). Your data never leaves the African region. We use TLS 1.3 encryption in transit and AES-256 at rest. No patient or claim data persists on WhatsApp or Meta servers. We are registered as a data processor under NDPA 2023.
The AI does not make final decisions — humans do. ClaimsIQ provides a risk score and plain-English reasoning. For HIGH and FRAUD FLAG outcomes, a human reviewer must take action before anything is logged. The AI can be wrong — that is why the human is always in the loop. Every decision, correct or not, is logged with a mandatory reviewer comment.
Image Intelligence is available from Month 7 as a Growth tier feature. Staff send a photo of the pharmacy receipt, discharge letter, or vehicle damage to the same WhatsApp number. Vision AI extracts structured data — drug names, amounts, diagnosis codes, damage zones — and presents it alongside the original image for the reviewer. No manual re-entry. Original image stored with a SHA-256 hash for tamper-evidence under NDPA 2023.
ClaimsIQ timestamps every claim at receipt. The NIIRA deadline countdown is displayed on every motor claim in the reviewer dashboard. A timestamped receipt → review → decision chain is maintained automatically and forms the Section 210 audit evidence. Your compliance team can export a full claim log at any time.
A standard pilot is 3 months at Starter tier. Week 1: onboarding and WhatsApp number setup. Week 2: first live claims. Week 3 onwards: full operational mode. We target your first AI-triaged claim within 5 business days of signing. No long-term lock-in on the pilot — you renew based on results.
No. ClaimsIQ uses Claude Sonnet — a large language model from Anthropic — as its reasoning engine. We do not train a custom model on your claims data. Your data is used to process your claims and is never shared with Anthropic for training purposes. Anthropic's API terms confirm no training on API inputs. You can request our full data processing agreement at any time.
Book a 30-minute demo. We will show you a live prototype and answer every question your compliance team has.