Insurer
pain point |
- Audits are labour
intense and take a
long time
- Reviews on only a few
randomly selected
claims bring the fear
that large hidden
claims are not spotted
- No real understanding
of the portfolio
beyond what is in the
structured data
|
- Labour intense,
typically scales with
number of employees
and their cognitive
abilities
- Error prone because of
human input
- Only a few data points are stored in the system and thus available for analysis. All
other information from the communication is discarded
|
- Validation of reservations and payments is
manual, delayed,
time-consuming and
error prone
- Significant leakage of
overpayments because of lack of control
|
- Error prone invoice
capturing process
- Delayed reserved
adjustments and
approvals for
settlement
- Customer complains
|
DGTAL
offering |
- Digitize the whole claims portfolio
- Train AI models to spot over/ under reserved claims, unusual movement, potential fraud, inactivity etc., all worth a manual review
- Reports summarizing portfolio review
findings
- Portfolio slice & dice reports per topic (i.e., per LoB, country etc.)
|
- Keep all information searchable
- Reduce the time humans spend on inserting information
into the system
- Spot critical claims
early and triage
- Topic Modelling ie Understand the Documents automatically,
Claims Summary, Key
Information Extraction, etc
|
- Increase transparency and accuracy in the validation,
reservation, and settlement process
- Automated cross-checking of invoicing, statements, external data sets and reports
|
- Automated reserve
adjustments
- Automated payment
- Automated validation
|
Expected
outcome |
- Full portfolio claims
reviews completed in days
- 100% of clams reviewed
- Fast remedial action based on findings
- Improving reservations by identifying
over and under reservations
|
- Increase information accuracy
- Proactive claims handling
- Early detection of
severe claims and cost of capital reduction
|
- Reduced response
time, manual intervention and leakage
- Better claims journey for the customer
|
- Faster release of
outstanding reserves
- Clerks focus more on
H2H tasks
- Improved customer
satisfaction and
retention
|
