Automating Claims Management with AI
THE PROBLEM
A leading international insurance company set out to automate claims review and assessment with AI to improve accuracy, reduce fraud risk, and contain implementation costs.
For the company, the claims management process was highly complex and costly due to the large volume and variety of documents, given the large quantity and heterogeneity of the documents to be analyzed, together with the detailed data to be extracted from each document. Furthermore, standardizing the evaluation of each document provided by customers was critical to reduce inconsistencies caused by different operator experience and skill levels and to limit financial losses from excessive compensation.
THE SOLUTION
The company adopted Expert.ai’s AI solution to streamline claims management, focusing on automating the analysis of medical reports to increase productivity and allow operators to focus on higher value-added activities. Using domain-specific knowledge models for insurance, the system applies text analysis and entity extraction to identify document types (medical reports, invoices, forms), analyze the text, extract the necessary data for settlement decisions, and flag exceptions, such as fraud indicators or inconsistencies.
With AI, the insurer improved accuracy, increased efficiency across the claims process and significantly reduced error rates, freeing operators to focus on higher-value tasks. This not only enhanced customer interactions but also strengthened brand reputation.
BENEFITS
- 58% reduction in claim review time
- 8 hours saved per claim review
- $40 million reduction in annual underwriting losses
- Greater accuracy across the claims management process
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