Abstract: In terms of maintaining hospitals' financial health, immediate and accurate insurance claim settlement is essential to guaranteeing patients receive continuous, high-quality care. Notwithstanding the importance of it, a number of enduring issues frequently impede the current hospital insurance claim settlement procedure, such as complicated documentation requirements, ineffective manual workflows, and inadequate communication between insurance companies and healthcare providers. Delays, a decrease in transparency, and an increase in administrative the workload are all caused by these obstacles.

The objective of this study is to systematically pinpoint the main inefficiencies in the hospital's insurance claim settlement procedure and offer feasible remedies to improve operational effectiveness. The study aims to identify useful breakthroughs by carrying out an in-depth look of actual hospital operations, collaborating with important stakeholders such as billing departments, insurance representatives, and healthcare administrators, and assessing the future potential of digital innovations like automated claims management tools, electronic health records (EHRs), and health information systems (HIS).

The results indicate that the cornerstone for creating a quicker, more reliable, and patient-centered settlement of claims system is process standardization, strong digital integration, and open lines of communication. the findings of the study, healthcare organizations may substantially cut down on claim processing time, minimize errors, and eventually increase patient satisfaction and organizational sustainability by embracing technology while establishing a collaborative environment.

| DOI: 10.17148/IARJSET.2025.12541