OPTIMIZED MEDIPROBE

PRESENTATION
 AGENDA

Insurance Industry
Business Opportunity
OPTIMIZED MEDIPROBE
Investment Sought
Deployment of Investment
INSURANCE INDUSTRY IN INDIA –
SNAP SHOT
PARAMETERS STATISTICS

Market Size Indian Insurance market is estimated at US $131bn as of FY22.

Grew at CAGR of 17% over the last two decades and is expected to
continue its growth trajectory
India is expected to be 6th largest insurance market in the next 10
years.
Fraud Industry estimates, insurers lose close to 10 per cent of their overall
Detection premium collection to frauds.
Insurance frauds are typically committed at the time of applications
or claims
Estimated to cost ₹45,000 cr. to insurance companies

Nearly 70 per cent of these frauds are committed through false

documents.
Current fraud detection ratio is around 20-30

India will be one of the top 10 countries with huge Risk Management
business opportunity.
INSURANCE INDUSTRY -
CHALLENGES
 Insurance companies face challenges due to
 Increased competition,
 Elastic marketplace
 Complex claims processing
 Increasing Frauds
 High customer expectations
 Tight regulations.
 Explosion of data generated from different sources that needs to be
managed & analyzed.
 Availability of large amount of text data but:
 Data lying in different silos
 Small percentage, less than 15% data is structured and processed by
companies.
 Valuable business insights hidden in these unstructured data yet to be
unlocked
INSURANCE INDUSTRY –
CHALLENGES………..Cont
• Companies continue to face challenges in most aspects of their business:
 Underwriting
 Product pricing
 Sales and customer experience
 Claims handling
 Loss prevention
 Fraud detection
 Legal and compliances escalations

By way of time, competition and resources

Fraud investigation processes like historical data check, social media check, third
party data check, etc continue to be manual or partially manual

Quality of data supposedly representative and balanced falls short in predicting

security and risks.
INSURANCE INDUSTRY AUTOMATION
– CURRENT STATUS
Automation in Insurance sector largely provided by
IT companies by way of Software Products or
services or both
Driven more by technical experts rather than
domain experts
Products focussed towards
 Capturing data/ transactions
 Workflow automation
 Digitization of documentation
 Statistical Analytics
BUSINESS OPPORTUNITY
End to end AI and ML based software solutions for
Insurance Industry to :
o Automate processes for targeted and effective sales
o Better customer experience
o Prompt & real time claim management
o Risk mitigation
 Fraud detection ratio can be taken to 70-80% with minimal
cost.
 Predictive prevention rather than detection
 Predictive and Prescriptive mode of Risk management.
o Compliance & Statutory Regulations
OPTIMIZED MEDIPROBE
Optimized Mediprobe has evolved precisely to address this opportunity

Optimized Mediprobe is an amalgamation of two well-known companies

o AuctusSol Inc., USA (Formerly known as Optimized Solutions) &
o MediProbe Consultancy Services Pvt. Ltd.

Brainchild of Mr. Sam Reddy and Dr. Ramesh Khade, visionaries who have carved
a special place for themselves in the fields of Technology, Healthcare and Insurance

Collaboration promises to bring in disruptive processes by using advanced AI

techniques in
o Risk analysis,
o Fraud detection
o Higher degree of data protection
o Business process assurance.
 BUSINESS ENTITIES

AUCTUSSOL MEDIPROBE

TECHNOLOGY DOMAIN
EXPERTISE EXPERTISE

OPTIMIZED
MEDIPROBE

AI & ML BASED INSURE-TECH COMPANY

Dr. Ramesh Khade

Dr. Ramesh Khade, founder of Mediprobe Services Pvt. Ltd. is an eminent name
in the field of Medical Intelligence for more than a decade.

Highly acclaimed professional in the field of insurance claims, crisis

management, insurance fraud investigation, and corporate insurance
management.

Graduating in medicine in 1995, his 15 years of experience as a medical

practitioner also includes two years in Forensic Medicine.

Subsequently promoted Mediprobe Services in 2010

Over the years, Dr. Khade’s distinguished capabilities have been a catalyst in the
organization’s growth which has carved a niche for itself in the medical
intelligence field.
Sam Reddy
Sam Reddy is the Founder and Director of AuctusSol
Inc. apart from other successful organizations. 
Began his journey as an entrepreneur building a
family-owned business
Started Optimized Solution two decades ago in U.S
with principal partnerships with SAP and other
technology companies
Riding the technological wave as early adopters, the
promise of AI and ML has been leveraged for
information processing in real-time.
MEDIPROBE….INTRODUCTION
 Mediprobe is a 12 years old organization catering to Insurance
companies
 Pioneers in providing multiple Risk Management/Investigation
services and a leader in Indian Insurance Risk Management market.
 Presently has a client base of 23 leading insurance companies in the
country
 Started with health insurance investigations, now covers other
insurance domains like motor and life insurance also.
 Team consists of over 100 domain experts and more than 300
trained field executives,
 Mediprobe has been the best performer in the insurance
Investigation industry with its unique skills, domain expertise and
technology,
MEDIPROBE - INTRODUCTION
 MediProbe is India’s leading Medical intelligence company, working
in Indian Insurance sector for over a decade.
 In-house team of medical, insurance, legal and forensic experts.
 Provides Investigation and fact-finding Services in various fields.
 We use many investigation tactics to help insurance companies
reduce their exposure to deceitful acts of claimants.
 Mediprobe has topped Indian Insurance Fraud Investigations Market
for last 10 years
 Has a strong client base with high level of trust and dependability.
 Highest ratio of fraud detection and denial of claims with relevant
documentary evidence….Key to our success.
PARTIAL LIST OF CLIENTS
AUCTUSSOL INC.
US based Technology Company with vast experience
in field of Data optimization and AI solutions
AuctusSol Inc is a global IT services organization
providing business enterprise solutions to clients for more
than 25+ years.
AuctusSol has a strong portfolio that includes Digital
Transformation, Cloud, In-Memory Computing, Predictive
Analytics, Mobility, and User Experience.
Enterprise IT solutions deployed by AuctusSol has helped
Fortune 1000 businesses increase ROI, reduce TCO and
drive competitive advantage
OPTIMIZED MEDIPROBE –
REVENUE STREAMS
Mediprobe shall be merged into Optimized Mediprobe
Following merger OM will have two business verticals:
o "Investigation" - Provide Risk Management and Investigation
services with Field visits and Virtual investigation
o “Insuretech Services”- End to end AI and ML based SaaS software
solutions/platform catering to Insurance Industry.
 AI platform shall be used by OM and deliver services to its clients
 AI platform can also be used by clients directly for a subscription fee
chargeable by OM
• Third Business vertical would be as a TPA as part of offerings
to existing captive customers
Growth to be achieved by both organic and inorganic means
o Acquire at least two outfits one each in Motor & Life insurance
OPTIMIZED MEDIPROBE –
OPERATIONS
Optimized Mediprobe is already registered as a
Private Ltd. Company (under start-up India Program)
Company has already kick started its operations
Business analyst and Domain experts in place apart
from Software development team.
o Resources in Hyderabad - 3
o Resources in Pune – 12
Development of AI Platform has already commenced
Head office located in Hyderabad and branch office
at Pune
OPTIMIZED MEDIPROBE - ADVANTAGES
OM is a Insure-tech company with deep domain knowledge
background, all competitors are basically software companies.
Promoters of OM are combination of Domain and Technological
expertise each with experience of over 25 years
Captive customers of Mediprobe (23 insurance companies) who
have been with Mediprobe since last 10 years become customers
of OM.
Post merger anticipated revenue of 10cr for 2022-23 of Mediprobe
will be transferred to OM.
Optimized Mediprobe is already in talks with 5 of them who are
keen to utilize the platform once it is ready
Optimized Mediprobe gets to use the data of more than 1.5 lakh
cases collected by Mediprobe over last 10 years for analysis
OPTIMIZED MEDIPROBE –
PROPOSED GEOGRAPHY COVERAGE
Operations recently started from India.
Plan to make inroads into global market in a phased
manner.
 Phase I: India and UAE market
 Phase II: Asia, Africa and South America
 Phase III: Australia, US and Europe
GROWTH OPPORTUNITIES
Presently all customers are private Indian insurance
companies
Government entities have much larger budgets:
o For ex: Orissa State Government has a budget of 6000 cr.
towards insurance
o 1.5 % is earmarked for Fraud detection & Risk Mitigation
o Similarly various other State Governments have large
budgets for insurance
o Public sector Insurance companies in India
Foreign partners of Indian Insurance companies who are
existing clients can be tapped for global expansion
INVESTMENT SOUGHT (INR CR.)
YEAR PHASES AMOUNT

2023-24 Phase 1 25

2024-25 Phase 2 25

2025-26
UTILIZATION OF FUNDS (INR CR.)
PHASES PURPOSE INVESTMENT YEAR
AMOUNT
PHASE I Product & AI Platform Development 6 2023
Database Procurement 3
Acquisition of firm (Providing similar 8
services to Life Insurance companies)
Sales & Marketing 4
Operational Expenses 4
TOTAL 25
PHASE II Global Market Research 3 2024
Global Marketing & Branding 8
Database Procurement 6
Acquisition of firm (Providing similar 8
services to Motor Insurance companies)
TOTAL 25
 REVENUE PROJECTIONS - INVESTIGATIONS
(INR.CR)

FY India MEA APAC Australia Europe Americas Total

2023-24 25 8 5 0 0 0 38

2024-25 35 20 10 10 0 10 85

2025-26 50 40 20 20 0 20 150

2026-27 70 80 40 25 10 50 275

2027-28 100 100 50 30 20 70 380

 REVENUE PROJECTIONS - INSURE-TECH
(INR.CR)

FY India MEA APAC Australia Europe Americas Total

2023-24 5 8 5 10 0 10 38

2024-25 15 20 10 20 15 35 105

2025-26 30 40 20 25 30 70 215

2026-27 50 80 40 30 50 100 350

2027-28 100 100 50 50 100 150 550

REVENUE PROJECTIONS - GLOBAL TPA
(INR.CR)

FY India MEA APAC Australia Europe Americas Total

2023-24 1 2 1 0 0 0 4

2024-25 3 6 3 15 15 30 72

2025-26 5 10 5 30 30 60 140

2026-27 10 20 10 40 40 80 200

2027-28 20 40 20 50 50 100 280

 PROFITABIITY
YEAR OFFERINGS REVENUE EXPENSE PROFIT PROFIT (%)
INVESTIGATION 38 30 8 21.052
INSURE-TECH 38 30 8 21.052
TPA 4 4 0 0
2023-24 TOTAL 80 64 16 20
INVESTIGATION 85 70 15 17.647
INSURE-TECH 105 80 25 23.809
TPA 72 70 2 2.7777
2024-25 TOTAL 262 220 42 16.030
INVESTIGATION 150 120 30 20
INSURE-TECH 215 180 35 16.279
TPA 140 130 10 7.1428
2025-26 TOTAL 505 430 75 14.851
EXPENSE HEADS
EXPENSE HEADS 2023-24 2024-25
Investigation 14 45
Sales & Marketing Cost 8 44
Infrastructure 8 22
IT Maintenance 2 10
Operations 1 10
Tax/ Compliance 6 14
Administrative 3 10
Data Procurement 3 10
Salaries 12 45
Finance Cost 3 10
TOTAL 60 220