Automating the Claims Process with Artificial Intelligence and Machine Learning

Automating the Claims Process with Artificial Intelligence and Machine Learning

Workflow Automation, Litigation Prediction, Fraud Recognition with Charlee™

 Five Minutes with the Infinilytics’ Innovation Team

 The last several months have caused the insurance industry to change in so many ways. Some insurance companies are reporting a decline in revenue while others are maintaining or have increased.  The pandemic, hurricanes, and wildfires cause turmoil in the claims systems with backlogs, delayed payment processing, lack of claims resources, and perennial charlatans and fraudsters. They always emerge in these catastrophes preying on victims and insurance carriers.

Leverage Artificial Intelligence in Your Remote Work Force

The COVID-19 pandemic has forced claims and policy teams to adapt and leverage digital technology at an accelerated speed.  The remote workforce ecosystem The remote workforce accelerated the insurance industry to quickly adapt and start using digital technologies on a broader scale.  People have adapted to conducting business with these technologies (think of Zoom, Slack, Skype, etc.); however, how can claims and underwriting executives ensure that their workflow process is efficient and effective in the new remote work environment? How can you reduce bottlenecks in the process and identify valuable and critical insights into the claims process?

Introducing Charlee™ – The First Insurance A.I. Insights Engine

Infinilytics has built the first insurance insights engine[1] for the insurance industry. An insights engine is a powerful tool to extract insights from a variety of structured and unstructured data. The Charlee™ Search insights engine was trained on over 35 million claims and has 3,000 insights ready to go when deployed. The Infinilytics Team has created and built the required ontology[2] for the insurance claims process.  There is also a powerful semantic search capability for words and phrases utilized in categorizing the types of loss, causes of loss, and the unique characteristics of each kind of claim in each line of business.

—————————————————————————————————

[1] Insights engine defined: https://www.gartner.com/en/documents/3961025/magic-quadrant-for-insight-engines

[2] An ontology for artificial intelligence specific for insurance is the knowledge base (business expert) combined with models and unique knowledge representation that powers machine learning algorithms and the search engine.  

Automation for the Claims Process

Charlee provides fraud and litigation predictions in the form of flags and a score. The claims are scored (0-100) at the first notice of loss and vary based on the severity and number of flags. The score refreshes every time the claim receives new information such as a document, recorded statements, and third-party party reports. Based on the score, you can assign specific ones to senior or specialist adjusters for fair resolutions and cost-efficient process.

Benefits of A.I. in the Automated Claims Process

Imagine being able to reduce costs and save money on needlessly processing claims while still providing superior customer service. Advanced A.I. can start to automate the claims process, thereby freeing up time for your Examiners and Claims Specialists to focus their time on more severe claims which might, or will, end up in litigation. The Infinilytics’ Charlee A.I. Suite provides recommendations (based on industry best practices), fraud alerts, high severity pattern analysis, and litigation prediction.  Charlee™ also acts as a cyber-supervisor that monitors your pending claims and how your Examiners are adjudicating the claims. Charlee™ will identify the most severe and potentially high-cost claims and bring them forward, so you improve the processing more efficiently, effectively, and timely. These efficiencies can also have a favorable impact on reducing outside investigative vendor and independent adjuster expenses, thereby decreasing Allocated and Unallocated Adjustment Expense.

Moving Forward

Digital technology platforms, like Charlee™, will not replace the human claims examine or agent, but it will significantly assist them in their jobs.  Charlee™ delivers round the clock insights on current claims for litigation, fraud identification, catastrophic incidents, and government compliance deadlines (think of government regulations and specific data calls).  Simplicity, efficiency, personalized service, and low cost is what customers expect from an insurance company. Charlee™ helps you meet these expectations.

Infinilytics has innovated in artificial intelligence and machine learning with Charlee™.  Your customer experience and success stories will highlight your team’s ability to adopt advanced technologies in our ever-changing world quickly.

Contact us at info@infinilytics.com or: (844) 826-6906 to schedule a demonstration of Charlee™.

No Comments

Post A Comment