Our customer is a leading Fortune 500 premier insurance company in the US catering to a diverse set of specialty, niche-market insurance products in property, casualty, extended device protection, and preneed insurance sectors. The insurance carrier had huge volumes of claims received daily through multiple offline and online channels with more than 35% of contact center calls being claims related. Among all claims received, a significant volume was paper-based claims and required a manual process. There was a high error rate in claims adjudication like missed benefits, under-payment, or over-payment which led to fines and penalties. In addition, there was a high probability of fraudulent transactions during claims.
High Volume of Claims: The company receives a substantial daily influx of claims across various channels (online, offline) with a significant portion dedicated to contact centre calls and paper-based submissions.
Manual Processes: A large portion of claims processing remains manual, hindering efficiency and potentially leading to errors.
Errors in Adjudication: Manual processing contributes to a high error rate in claims adjudication, resulting in missed benefits, underpayments, or overpayments, and potentially incurring fines.
Fraudulent Transactions: The paper-based system and manual processes increase the likelihood of fraudulent claims slipping through undetected.
Solution.
Coforge leveraged orchestrated AI with RPA for transforming claims intake and management. Some solution accelerators used are:
Coforge Document AI proprietary solution for intelligent document processing of structured, semi-structured, and unstructured documents
Coforge ML-based IVIS solution for Claim triage and adjudication
Intelligent RPA bots for task automation in both attended and unattended form
Advanced analytics based on knowledge graph for customer profiling, customer behavior analysis, and fraud forensics
Process discovery and mining using Coforge ProcessGym[TM] leading to sustainable demand generation
The Impact.
End state savings of more than 75%, that includes process, design, automation, right shoring and business model change.
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