Artificial Intelligence And Its Applications In Simplifying Claims Processing

Unlike traditional processing of the claims, the introduction of the artificial intelligence in the insurance world has made the claims process smoother than ever. Though earlier many assumed artificial intelligence as a science fiction thing, this concept as finally manifested its relevance in various industries and is consistently gaining momentum as an essential tool for automating complex business operations.

While insurers find claim processing as a daunting and time-consuming function, higher customer satisfaction, reduced claim costs and less loss ratio are some of the key objectives insurance industry is striving to accomplish. Since a customer already has suffered a big loss, he/she doesn’t want to take the further stress of complicated processing of the claims and expects his/her insurer to face the moment-of-truth. Here, the role of AI comes into play in making claims processing more efficient as well as in detecting fraudulent claims.

Automated claims processing is reshaping insurance industry by delivering efficient, customer-centric solutions from First Notice of Loss to final settlement. Additionally, AI- enabled insurance software is enhancing productivity, aiding customer satisfaction, cutting adjustment expenses and reducing TAT for settling claims. Here, we are discussing few ways AI is helping insurers with smarter processing:

Faster Claims Processing Automation

Though digitalization has made insurance industry to adopt digital solutions for handling claims processing efficiently, some of the companies are operating manually. They initiate claims processing with matching claims with customer’s information stored in their databases. Finding this data could be challenging and thus, it takes more time than expected.

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But AI has made its mark in this industry. It excludes manual tasks and provides better end-to-end claims processing automation. It facilitates the process by integrating information in different systems and thus, reduces the period and cost of claims handling significantly.

Effective Handling of the claims

AI- enable insurance software automatically carries out most of the tasks while freeing up claims adjuster to focus on other key aspects like evaluation of the claims, its investigation, and handling of the negotiation part. Even customers can take the advantage of this software by checking the history of the submitted claims as well as status of the current claims. Additionally, they can submit their claim applications online.

Intuitive Response

Since a customer is known for ruling the market, insurance industries intend to deliver a seamless experience to their customers including faster claim settlement, Omni-channel support services including phone, email, and social media. But this is not possible when handling claims manually and hence, sometimes companies end up creating a wide gap between customer’s expectations and the level of service delivered to them.

Here, AI comes in and provides seamless customer experience across multiple channels for all stakeholders. It modifies the communication and information flow between claims agents and customers involved in the claims process. With having omni-channel communication and various data sharing sources, insurers get a clear view of the claim and thus, able to deliver faster and consistent responses to their customers.

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Cost-effective solutions

AI significantly cuts down insurer’s costs by providing accurate claims settlement solutions. It holds the capacity of checking repairs that needs to be made and estimates their costs. In addition, it helps adjusters to focus on other works by automatically analyzing damages done through photos. Also, it tells if any repair, salvaging, or assessing needs to be done or not. But, the final decision is solely taken by the claims handler itself.

Detection of Fraudulent claims

Every year insurance industry suffers a loss of 50 billion dollars reportedly due to the settlement of fraudulent claims. And, as a fact, generally, this fraud detection is done right after the settlement is made in contrast to the initial phases when it could be mitigated easily. However, the experts in this industry have started taking proactive measures and implementing innovative technologies and tools to detect fraudulent claims. Even though, many smaller firms sometimes fail to notice suspicious activities.

For such companies, AI, due to its higher intelligent automation process, opens the door and help them to recognize fraudulent claims. Further, AI’s capability of pattern-spotting and understanding contextual data enables insurers to keep a constant check on the information flow as well to access customer’s claims history. This, in turn, facilitates the detection of anomalies and segment cases that seems to fall under fraudulent claims early-on.


by Andrew Hudson