By: Dinesh Ghevade, Senior Consultant

Claims processing is at the heart of Insurance business, and relies heavily on short turnaround times, accuracy in investigation and calculative evaluation to meet the customer commitment, drive credibility. Customer satisfaction is achieved by minimizing severity and maintaining high efficiency.

However, several challenges exist all along the claims processing value chain such as:

• Lengthy processing after FNOL
• Cumbersome manual and repetitive processes
• High number of touchpoints
• Lack of transparency
• Change in severity and increase in frequency
• Exponential increase in settlement cost
• Increase in fraud and decrease in recovery
• Increase in litigation and legal expenses

The good news is that Intelligent Automation is set to digitally transform claims processing in the Insurance industry by transforming legacy systems and making the process more intelligent and streamlined with self-driven workflows, but without requiring massive system or operational overhauls.

Let’s look at how Intelligent Automation can transform the claims processing function:

AI
AI technology can change the entire claims processing approach from using bots for initiating claims and responding to user queries, to using AI based drones for remote assessment of site of loss and data capture. AI bots can self-learn from the previous claims they handled and create patterns which makes customer management, fraud management, investigation, evaluation and claim settlement easier.

RPA
Robotic Process Automation (RPA) eliminates human error caused by entering data manually into the COTS system, and reduces the number of touchpoints involved in the claims process. RPA automates repetitive, manual tasks freeing up employees to focus on more business critical tasks and innovation. Thus, balance workforce can be utilized for more judgmental tasks and tasks that need more human thinking.

Data Analytics
Automated data analytics help in predictive and present situation analytics on claims which helps lower fraud, predicts reserves and settlement cost accurately, provides litigation success rate and predicts recovery, thus enabling smooth closure of a claim.

Speech Analytics
Speech analytics converts unstructured conversations into structured output and enhances evaluation of tone, emotions of customers as well as CSRs. By using speech analytics, Insurance firms will be able to build innovation in customer management and improve operations, increase customer retention and reduce fraud.

IoT
The revolutionary IoT technology has a lot to offer the Insurance industry. It can use remotely connected devices to monitor the environment and scan it for possible hazards, thus pre-empting and preventing a loss. It helps control and manage the automation a well as human intervention thus making the claim processing smooth.

Machine Learning
Machine Learning mainly focuses on self-learning through data feed, and historic decisions based on the same type of claim and key variables. This helps reduce the cycle time and predict the outcome.

Natural Language Processing (NLP)
NLP allows machines to understand the context behind the communication and take action based on prebuilt data, which comes in very handy during the claim intake stage.

Business Intelligence (BI)
BI helps in faster, accurate reporting and analysis with the help of data mining, providing excellent data visualization, and allowing users to create intuitive reports which are easy to interpret and understand. This helps in planning and strategizing future claims processing.

OCR
OCR is used for smartly capturing the data from different FNOL forms by reading forms, images, scans and converting them into formats that machines can understand like tables, Excel sheets etc. With the help of other enablers this data can be processed for further Claim prediction.

It is clear that the Insurance industry is looking at taking serious steps forward to transform and automate claims processing. There is a definite sense of urgency to adopt low-touch or touchless claims processes driven by numerous measurable benefits. Automation will not only transform the claims process but will also help in reducing or preventing the losses that trigger the claims process, thus saving the customer the trouble of going through a “merry-go-round” while saving Insurers operational costs.

Intelligent indeed!!!