Securing Health Insurance Claims with Decentralization and Transparency: A blockchain-based Approach
Abrar Ahmed Raza, Bhavna Arora, Mohd Tahir Irfan · Procedia Computer Science · 2025
The rise in fraudulent health insurance claims, due to the manual processing of medical insurance claims within traditional systems, needs innovative solutions to overcome these fraudulent claims. Health insurance fraud occurs when insured individuals or medical service providers intentionally submit false or misleading information to exploit insurance policies for unfair advantages. To address these challenges, blockchain technology is emerging as a promising solution. The blockchain has the potential to beat the conventional centralized system, which suffers from a severe lack of accessibility. The utilization of blockchain technology is witnessing a remarkable surge in various domains of technology on daily basis. In the past decade, developers, researchers, and experts have shifted their focus towards decentralized technology instead of centralized systems, owing to its trustless nature, immutability, continuous accessibility, and robust data integrity. In this paper, the application of blockchain technology for health insurance claims is reviewed to mitigate the fraudulent claims. Moreover, a blockchain-based health insurance claim management system is proposed which utilizes the smart contracts and a distributed ledger to streamline the claim process. The system ensures secure and transparent interactions between the key stakeholders involved, including patients, and healthcare providers. Further, the proposed solution aims to enhance the efficiency and integrity of the claims processing workflow. This study focuses on the advantages of using blockchain technology to process health insurance claims rather than the traditional human method, which is time consuming, costly, and prone to fraud.