Over the years, insurers have invested greatly in more streamlined, but still largely manual processes for managing claims. Artificial intelligence (AI) provides new opportunities for the insurance industry to improve efficiency and agility.
At its simplest, claims assessment processes typically involve 4 key elements:
1. Gathering Information Claim assessors must handle and sift through dozens of documents and policies to verify each and every claim. Advanced AI-automation and Natural Language Processing can now effectively reduce the burden of searching for and finding the information related to the claim.
2. Eligibility Assessment Once the right documents and policies have been found, a claims assessor must manually process/review these and determine if they are relevant to a claim. Even after the tedious process of looking for the correct documents, the assessor will need to find specific information within those files that are important to the claim. Advanced Search, AI entity extraction, and Natural language methods accurately find information from within documents to process the claim and determine eligibility.
3. Assessing Benefits for a Claim Once a claim has been determined as eligible, the assessor must look through policies, updated underwriting provisions, or other internal documents. Similar to the Eligibility Assessment, finding the exact benefits the customer should receive can be a time-consuming process. It can even be susceptible to human error without an automation process that can properly classify, sort, and extract data.
4. Managing a Claim Through to Closure Lastly, it is not nearly enough to assess the eligibility and benefits of a claim. Insurers’ claim assessment process must ensure the claim gets resolved. Even better if the claim is closed in a timely manner, often reducing costs to the insurer and generally providing for better customer experience. Validation mechanisms and extensive audit logging in the assessment process can help catch errors, issues, and other roadblocks for closure.
At Search365, we’ve developed our Universal Search Claims Automation platform that uses the latest in AI and Search technologies to automate the claims assessment process for insurers.
First, is improving margins. By reducing
manual processing costs and time, insurance businesses are looking at a very
high ROI. Furthermore, because the process is faster and shorter with the
automation technology doing the tedious tasks, claim assessors will be able to
finish assessing more claims.
Claim processing also becomes more consistent
as claim assessors as the technology does not suffer from bias or differing
degrees of experience that are noted in a traditional team structure.
In turn, a consistent and agile claims processing workflow allows claim assessors to answer customers faster and more accurately which creates an overall smoother customer experience. In the heavily competitive insurance industry, a pleasant customer experience sets one business apart from another, irrespective of whether a claim is determined as eligible or ineligible.
Digital transformation is at the center of every executive and board discussion across the insurance industry. All businesses have to do is learn about the best technology and processes out there and effectively implement them to improve speed, accuracy, and efficiency.