Challenge & Pain Points:
Claims processing has multiple aspects including claims data extraction, fast vs investigative track (fraudulent claims) segmentation and actuarial policy compliance to name the foremost ones. Accuracy throughout the claims underwriting is the key to profitability. Though accuracy in costing and pricing is a prerequisite, profitability cannot be achieved without fast and accurate claims processing. While accuracy ensures planned technical profit realization by ensuring compliance with underwriting processes and the actuarial assumptions that were used in costing and pricing decisions, fast processing improves customer experience, increasing customer satisfaction and company reputation. The conventional pipeline involves manual processing which is not only prone to errors (over/under-coverage) but also increases processing times leading to customer dissatisfaction. Despite these conspicuous pain points, current AI applications in insurance almost exclusively target operational problems, more specifically data extraction via document processing, and underutilize the potential of AI in solving core problems by means of both improving conventional rule-based decision making via discovering efficient and effective rules, and going beyond it where simple rules are insufficient and/or require substantial human expert involvement, such as health status assessment in health insurance claims processing.
Insursight.ai Solution:
Insursight.ai provides full-fledged AI-driven automated claims underwriting. The solution provides fast and accurate claims processing, not only speeding up the process but also ensuring compliance to actuarial principles at the time of costing via determining the claims to be compensated automatically and optimally for both the beneficiary and the insurance company. Insursight.ai solutions do not only utilize the claims data but also the policy itself and the external data such as public health, weather, economy, insured’s credit score and social network, the claimer’s characteristics, etc.