CLAIMS AUTOMATION

Claims with no indications of fraud, complex issues, or potential litigation can resolve quickly, also known as “fast-tracking” or “workflow expediting”. Charlee assists claims management in identifying these claims for possible fast-track processing. This aids in expediting the claim to a prompt resolution, saving both time and expense. Also, the customer benefits from a faster experience. The key to fast-tracking is having the correct data, coverage, and simplicity for assignment to the right person for an expedited claim resolution.

Assignment of Claims to the appropriate Examiners

Use Case #CA1

Description: Claims are flagged at the First Notice of Loss and throughout the life of the claim, assisting in the assignment to the appropriate level claim handler.

The Charlee™ Insurance Insights Engine (patent pending) provides the claims team the capability to Fast-Track appropriate claims with no issues with coverage, liability or litigation. If the claim has no Quality Control (QC) Alerts, Red Flags (RF) or the propensity for litigation, Charlee™ clears the claim for an efficient resolution.

Starting with the First Notice of Loss through the final settlement of the claim, Charlee™ constantly analyzes the structured and unstructured text in the claim file, scanning all of the documents and external data, for patterns of high severity, litigation, and potential fraud.

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    Workflow Summary with AI Insights

    Use Case #CA2

    Description: Visualizing the performance matrix by Adjuster utilizing AI

    The volume of claims processed on any given day can be overwhelming for the Managers and Examiners in the Claims Department. Massive amounts of data flow into the Claims Management System through documents and conversations with involved parties to the claim. How can you accurately track the performance of your claims team? Insights, lots and lots of insights!

    The Charlee™ Insurance Insights Engine (patent pending) utilizes Artificial Intelligence and Machine Learning with Natural Language Processing (NLP) to help monitor the Claim Examiner’s performance, including the progress towards resolving a claim. In addition, the increased severity of claims with specific Topics and Entities can be closely measured and evaluated. The Claims Manager can quickly identify and take appropriate action to improve the job performance of the claims team.