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Automated Claims Processing for Insurance Providers

Insurance claims processing automation with intelligent document processing and intelligent process automation

INDICO RESOURCE

F50 Insurance company achieves 300% ROI with Indico Data

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The ability to efficiently process claims is crucial for all insurance companies, but it's been labor intensive in the extreme, involving massive amounts of unstructured documents and images. A solution can be found using which applies artificial intelligence (AI) to automate insurance claims processing.

In the past, for relatively simple claims, insurers achieved straight-through processing (STP), a degree of automated claims processing that requires no human intervention. But even in more complex instances, utilizing intelligent document processing for claims processing can speed handling by 4x or more. IDP allows firms to process more claims faster, keeping clients and customers happy. Insurance claims processing automation also means it takes fewer employees to do the job, freeing up key staff for more strategic work.

Learn how a F50 Insurance company achieves 300% return on investment with Indico Data.

Applying artificial intelligence to insurance claims

Advanced intelligent document processing platforms employ artificial intelligence technologies, including natural language processing, machine learning and transfer learning. Together, they enable employees who actually process claims to build insurance claims processing automation models – without involving data scientists, or even IT. That delivers a higher level of model accuracy and significant scalability, boosting insurers' ability to roll out automation models across the company.

Insurance claims automation: email processing

Chief among the areas that are ripe for automated claims processing is the corporate email in-box. It’s common for insurance companies to have a single email address to which clients send claims information. Some use the same address for general information requests, including quotes on new business. Or, customers mistakenly use a generic address to submit a claim.

Many of these emails contain not only potentially complex requests, but attachments, such as ACORD forms, photos showing home or vehicle damage and the like. An intelligent document processing platform can essentially read and triage each email, determining where each should be routed.

The platform can also extract and read attachments, often dealing with them on its own. The Indico Unstructured Data Platform, for example, includes a large library of ACORD forms, often resulting in straight-through processing of the forms. In general, the Indico Data platform can ensure each email is entered to the correct workflow for efficient, automated processing.

Watch Christopher M. Wells, Ph. D., Indico VP of Research and Development, and Munish Arora, Associate Director of Advanced Analytics, Sun Life, in episode 2 of Unstructured Unlocked.

Automating first notice of loss (FNOL)

No matter how an insurance company receives word of a client claim, it’s sure to come with plenty of documentation. Much of it will be unstructured, making it beyond the scope of a robotic process automation (RPA) solution for claims.

An intelligent claims document processing tool, however, doesn't have the limitations of RPA for insurance claims processing. It can process any type of document, structured or unstructured. In the insurance first notice of loss scenario, that may mean accepting the initial claim (the FNOL), then validating the claim is covered by the client’s policy. Much of that process can be automated with a tool that “reads” the claim form, extracts pertinent data and inputs it to a claims management tool. Here again, STP may apply to simple claims while others can be prepared with all pertinent information already assembled for an adjuster, greatly reducing time spent on the assessment process.

Meet compliance requirements with explainable AI

A key concern in a highly regulated industry like insurance is the ability to explain why an automated, AI-based solution makes the decisions it does. If a claim is rejected, the insurance company must be able to explain in simple terms the reason behind that decision. A sound intelligent automation tool will make that easy, with an audit trail that makes clear – in plain English – the rationale behind each claim decision. Additionally, given insurance claims process owners create the automated models, the models naturally reflect the way they think during the claims assessment process.

Read our blog: How intelligent automation speeds up insurance underwriting and claims processing.

Outsmart insurance fraud perpetrators

Automation is crucial for insurance companies if they are to keep up with insuretech startups, or simply compete effectively vs. traditional competitors. It’s also important to helping detect fraud.

More than 7,000 insurance companies collect over $1 trillion in premiums each year, the FBI estimates, making them a prime target for illegal activity. The total cost of insurance fraud exceeds $40 billion per year, the FBI says – and that doesn’t include health insurance. That costs the average U.S. family between $400 and $700 per year in increased premiums.

Automation can help insurance companies do better. To learn more, see our page, “Intelligent Document Processing for Property & Casualty Insurance" or click below for an interactive demo, a free trial or to get in touch with any questions.

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