Sembuh AI: Revolutionizing Insurance Claims with AI

Sembuh AI is an Indonesian insurtech startup on a mission to streamline how insurers handle health insurance claims. Its AI-powered platform automates labor-intensive hospital claims processing, detecting fraudulent cases and settling claims in seconds rather than hours. By accelerating payouts and flagging anomalies in real-time, Sembuh helps insurers cut costs, boost accuracy, and deliver faster, fairer settlements to patients and providers.

Why They Stand Out

• Lightning-Fast Claims Automation: Sembuh’s proprietary AI slashes claim processing times from hours to as little as 15 seconds, a transformative leap in an industry often bogged down by manual workflows. This speed improves customer experience and frees adjustors to focus on complex cases.

• Smart Fraud Detection & Cost Savings: The platform uses advanced machine learning to catch fraudulent or anomalous claims that humans might miss, reducing overpayments and ensuring legitimacy. By spotting patterns of fraud early, Sembuh protects insurers’ bottom lines while building trust in the claims process.

• Deep Local Healthcare Insight: Built by a team with firsthand experience in Indonesia’s healthcare and insurance system, Sembuh is finely tuned to local challenges. Its models parse Indonesian medical documents and billing codes with high accuracy, an edge over generic, global fraud solutions.

• Regulatory Tailwinds: Indonesia’s Financial Services Authority (OJK) introduced new anti-fraud regulations in 2024 that demand stricter fraud prevention. Sembuh’s platform offers insurers an AI-first, compliance-ready solution to stay ahead of these rules, making it both practical and timely.

Why Watch

• Massive Market Opportunity: Insurance fraud is a multi-billion dollar problem globally. In Asia, fraud-related losses in health insurance can reach up to 35% of total claim payouts. The fraud detection market is projected to grow from $4B to over $30B within the decade, Sembuh stands to ride this surge.

• Beyond Fraud, AI Expansion: While fraud detection is its beachhead, Sembuh’s broader ambition includes building AI tools for insurers, ranging from legal automation to predictive pricing and policy analysis. Its upcoming enterprise-grade GPT-like platform hints at a future where it becomes an AI copilot for insurers.

• Strong Early Backing: Founded in 2024, Sembuh quickly secured seed funding in early 2025 from accelerator-backed investors like Iterative. It has also gained national recognition from the Indonesia AI Institute for Progress, giving it exposure and credibility among early adopters and enterprise partners.

Meet the Team

• Claudio Perlini – Co-founder & CEO. A tech entrepreneur with international experience, Claudio leads product vision, AI strategy, and investor relations.

• David Jendra – Co-founder & Chief Operations. A Universitas Indonesia graduate and insurance practitioner, David drives operations and product-market fit using his deep healthcare domain knowledge.

WOWS Take

With massive whitespace in claims automation and supportive regulatory winds at its back, Sembuh AI is set to become the go-to AI claims engine for insurers across Southeast Asia. The startup’s ability to embed into daily operations (turning tedious claims into 15-second tasks) gives it a sticky, mission-critical quality that insurers will find hard to ignore. Their early momentum, lean approach, and domain-savvy founding team make Sembuh AI one of the most investable insurtech startups to watch in the region today.

Want to be part of the AI-insurtech wave for SEA?

Sembuh AI brought healthcare innovation center stage at our AI Demo Day. Watch their impactful pitch on WOWS Dealflow.