Missed Enquiries
Busy when they write
Someone asks about medical claims pricing or availability while you're with a customer · and never hears back the same day.
AI chatbot for
Medical Claims
Members, Adjusters, and Providers
When medical claims customers ask about claim status & timeline, pre-authorization requests, and document collection after hours, someone still needs to reply. NIVA answers from your own info, books the next step, and notifies your team · so warm enquiries do not go cold overnight.
- No usage-based billing
- Live across 25 industries
- White-label ready
70%
Query Deflection
24/7
Member Coverage
0
Code Required
Built for
Health InsurersTPAsClaims AdministratorsEmployer Plans
Current Challenges
If this sounds familiar, keep reading
Most medical claimsoperators aren't looking for complex tech. They want to plug real revenue leaks: fewer missed opportunities, less phone fatigue, and more automatic bookings.
Support Overhead
Same questions, every week
Your staff answer the same FAQs on phone and chat. Real work · quotes, visits, sales · waits in the queue.
Off-hours Dropoff
Warm leads go quiet
Night and weekend visitors leave without a path to book. By morning, many have chosen someone faster.
Core Capabilities
Where this helps day to day
Common medical claims situations your team still handles by phone and inbox · answered on the website instead.
Claim Status & Timeline
Members and providers check adjudication status, pending items, and expected completion dates without calling the claims desk.
Pre-Authorization Requests
Guide pre-auth eligibility, collect clinical codes, and open authorization cases with structured FNOL-style intake.
Document Collection
Send upload links for discharge summaries, invoices, and supporting records, and track what's still missing per claim.
Coverage & Benefit Verification
Answer deductible, co-pay, and procedure coverage questions from plan documents, with clear escalation to human review.
Provider & Network Queries
Help providers confirm network status, fee schedules, and claim submission requirements through chat.
Fraud & Duplicate Triage
Flag duplicate submissions, inconsistent dates, and high-risk patterns for adjuster review before payout.
What customers actually ask
Real questions from medical claimswebsites · answered in chat so your team isn't repeating them.
“What's happening with my claim CN-2024-88761? I submitted it two weeks ago.”
U
AI
Your claim is under review and one item is outstanding: the discharge summary from your provider. Everything else is complete. I can send you a secure upload link now, and once it's received the review typically completes within 5 working days.
Auto-resolved by Niva
“What documents do I need to submit for a knee arthroscopy pre-authorization?”
U
AI
For that procedure you'll need the referral letter, the procedure code, and the supporting imaging report. I can open the pre-auth case now and give you a secure link to attach all three, and your office will get the reference number immediately.
Auto-resolved by Niva
Why teams switch
Not another chatbot toy. A front desk that works overnight.
Missed enquiries after hours
Every website visitor gets a reply · days, nights, weekends
Your team repeats the same answers
Policies and pricing answered from your docs · consistently
Leads cool off waiting for a call back
Bookings, forms, and next steps happen in the chat
Teams already using NIVA
Up and running in a day
From a short setup call to live chat on your member portal in under a day, within your claims compliance boundary.
01
15 minutes
Tell us your business
Share how medical claims customers find you today · website, WhatsApp, ads. We map the questions that lose you money when unanswered.
02
Your team
Pick who answers what
Turn on helpers for sales, support, or bookings. They already speak medical claims · you choose which ones stay on.
03
Your docs
Add the knowledge you already have
Upload price lists, FAQs, policies, or page links. The assistant only answers from what you approve.
04
Go live
Put it on your website
It appears as your brand on the site you already run. No rebuild. Most teams are live within a day.
Ready-made medical claims helpers
Sales, support, bookings · switch on the roles you need. No writing from scratch.
Claim Status Bot
Status, timeline, pending items
Knowledge SyncLead Flow
Pre-Auth Coordinator
Eligibility, codes, intake
Knowledge SyncLead Flow
Document Collection Agent
Uploads, checklists, chase
Knowledge SyncLead Flow
Benefits Advisor
Coverage, deductibles, co-pay
Knowledge SyncLead Flow
Provider Support Bot
Network, fees, submission
Knowledge SyncLead Flow
Fraud Triage Agent
Duplicates, risk scoring
Knowledge SyncLead Flow
+ 4 more medical claims roles available on your walkthrough
Built around how medical claims teams actually work
Practical pieces that save time · not a pile of AI features to configure.
Plan & Policy Knowledge Base
Upload plan summaries, clinical policies, and provider manuals. NIVA answers from approved wording only.
Member & Claim Context
Returning members continue with open claim references, pending documents, and prior answers in context.
Pre-Auth & FNOL Flows
Automate intake, document chase, and adjuster handoff sequences with automatic updates to your claims system.
Claims Platform Integration
Connect to claims, TPA, or policy systems for live status and structured write-back.
Claim Status & Document Chase Flow
Trigger
Member asks status for claim CN-2024-88761
Lookup
Under review, discharge summary pending
Action
Upload link sent, reminder scheduled
Claims
Document received, adjuster notified
Pre-Authorization Intake Flow
Trigger
Provider requests pre-auth for procedure
Collect
Procedure code, referral, imaging report
Open
Case created with reference number
Route
Complete file queued for adjuster review
What visitors can actually get done
Beyond FAQs · for medical claims businesses that sell and support online.
Stop chasing
Work finished in the chat
Collect the right details, book the appointment, and notify your team · without bouncing visitors to another form.
See how it works Capture cleanlyDetails you can act on
When someone is ready, the chat asks for name, dates, budget, or requirements · and lands it in your inbox or CRM.
See how it works Feel humanThe right helper, every time
Sales, support, or bookings · visitors get the specialist answer they need, without choosing menus.
See how it worksOn your website. Looking like your brand.
Works on the site you already have · WordPress, Webflow, Shopify, or custom. Your logo, your colours, your name. Most owners are live the same week they start.
- No big rebuild of your website
- Changes show up for visitors without a re-launch
- We can add it with you on the demo call if you prefer
What founders usually ask
- Do I need a developer?
- Helpful if you have one · not required. Many medical claims teams paste one line or let us place it.
- How fast will I see value?
- Most start capturing overnight enquiries in the first week once knowledge and booking paths are set.
- What if it's not a fit?
- Tell us how you work today. We'll say plainly if a simpler setup or a rival product is better.
Compliance & Security
HIPAA AlignedGDPR / PrivacyISO 27001 AlignedPHI Handling Controls
See if this fits your medical claims business
Tell us how enquiries come in today. In 30 minutes we will show what NIVA would catch overnight · or say honestly if you are better with something simpler.
Common questions
Straight answers before you book time.
Yes. NIVA connects via REST API to surface claim status, pending documents, and write back intake data to your claims system.
Still unsure? Send a short note about how you work · we'll reply with a fit recommendation for medical claims.
Solutions Focus
Related use cases
See how NIVA handles day-to-day work in your space.
Vertical Markets
Related industries
Explore conversational agent options for adjacent vertical systems.
Niva Ecosystem