Claim process workflow

Highly manual process with increasing panorama of products and terms/conditions with evolving consumer demands impacts the coverage decision process resulting in high expense ratio. With the digitisation of claims process becoming the need and irrelevant documents and wrong information provided by customers resulting in delayed settlement impacting the customer experience.

Insurers can now fasten the claim processing by using AI Platform. It automatically understands the documents coming from businesses, auto shops or hospitals and provides all the necessary information required to adjust for processing claims. Also mapping the extracted information with the organisation or 3rd party master and providing indicators for right decision making.

Challenges in the claims processing.

Processing time management

Operational inefficiencies

Critical information processing

Fraud verification

Missing and incomplete information

Impact of our solution

Reduced processing time

Improved efficiency

Enhanced customer experience

Empowered human resources

Human eye accuracy

Handling peak volumes

Capabilities

Making your daily operations efficient

Do completeness check

On uploading the claim file, document classification is performed automatically and responds to any missing document required for complete processing

Handle different nomenclature changes

Any changes related to nomenclature is handled using ML based models which detects and maps the extraction based on the similarity of the data processed

Map 3rd party custom database

Extensive claim processing requires further intelligence in terms of category/sub category mapping or payable/non payable mapping which is enabled by integrating 3rd party or bring your own data sources

Enable routing & allocation

Medical summary is critical in processing and based on the information extracted automatic routing of the claim cases happens without any manual intervention

Configure custom rules

Due to high competition in terms of various insurance products, custom rules based on terms and conditions of various products have been embedded for efficient claim processing

Driving AI based decision making

To perform faster claim processing, unified view of claim is produced to drive the decision making faster


Automate your workflows with Pibit.ai