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