Redefining the Insurance Sector with Claim Process Automation

The blog discusses an Intelligent Automation (IA) solution by Coforge that helps insurers streamline their claims process and improve customer service. The IA solution uses machine learning and natural language processing to automatically analyze customer emails, classify claims, and provide instant responses leveraging a repository of pre-built resolutions. It can provide automated complete responses, partial responses with manual follow-up, or straight-through processing for straightforward cases. Key benefits include 30-40% increased operational efficiency, 10% quarterly growth in automated responses, 20% reduced labor costs, faster response times, and self-learning capabilities to continuously enhance the solution. The IA solution aims to boost insurers' revenue, operations, and customer satisfaction. 

Claim process is an indispensable service of the insurance sector that involves insurers receiving, investigating and processing a claim report submitted by a policyholder. Like any other insurance service, insurance claim process includes piles of paperwork and several hours of manual labor. For an insurance business, handling day-to-day claim-related email traffic and responding within SLAs (Service-level-agreement) is time and labor-intensive. In addition, these mundane day-to-day tasks negatively impact the productivity and performance of the service desk. On top of that, a lack of timely responses and effective solutions strike a blow at the credibility of a company in the long run. ;

A survey conducted by Super Office reveals that the fastest response time from a service desk is one minute while the slowest can be as long as eight days. On average, the response time is nearly twelve hours. In addition, 62% of the companies do not respond to the customers’ emails at all.

While waking up to this reality, service desks face a series of challenges, like:

• Long, cumbersome emails that complicate customer support
• Redundant manual task of email data extraction
• Complexity of tracking and recording service history
• Substantial amount of time spent in understanding the context of emails
• Constant pressure to provide quick response to customers

How the Intelligent Automation (IA) based Solution of Coforge is a game changer.

Our Intelligent Automation based solution plays on Machine Learning Technology (MLT) which empowers Insurers to respond to customers’ emails in real-time. The smart solution can analyze the text polarity of emails and employ Natural Language Processing (NLP) to assess the tone of the customer - whether it is positive, negative or neutral.

The biggest advantage of this cutting-edge technology is that it can classify claim policies, analyze them and reduce operation costs. Likewise, it also saves plenty of insurers’ time which is spent dealing thousands of documents, reviewing unstructured data, organizing, structuring and processing them.

Moreover, the solution is powered by an internal machine engine with a threshold of prebuilt automated resolution and is capable of effectively addressing 70% of the queries. For example, when the service desk receives an email, the IA solutions examine the email content. Then, it matches the terminologies used in the text with its pre-built engines and responds with a compatible solution to the customer within a few moments. The application is integrated with core systems so that it can gather important customer-related information seamlessly and put together an appropriate customized response in no time.

What happens if the subject matter of the email doesn’t match with the pre-built engines? In that case, the system automatically raises a ticket for the query and diverts it to the subject matter expert to address.

There are three ways the Intelligent Automation based Solution responds to customers’ queries.

1. Automated Complete Response – For every claim intimation email, the MLT identifies and categorizes the email text, matches it accurately with ML Engine’s pre-built resolutions and sends an instant response to the customer.
2. Automated Partial Response – If the claim/risk data in the email doesn’t match with any of the pre-built resolutions, it is diverted to the customer representative for manual response while simultaneously informing the same to customer with new service request details and assurance that they will soon hear from the service desk.
3. Straight-Through-Processing (STP) – Some cases are straightforward, and the system easily resolves them by processing them automatically. A claim request is created with a copy to the customer. For example, for a maturity claim where the benefit needs the amount to be paid, the system would authorize the finance department to credit the amount to the customer’s registered bank account.
   
   

One of the advanced features of Intelligent Automation (IA) based Solution is self-learning feedback mechanism. As the name suggests, this impressive feature empowers ML Engine to learn from the new entries and enhances the automated response repository.

Let’s take a look at how Intelligent Automation based claim process has not only nullified the human error and inaccuracies but has also streamlined the entire process.

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The number speaks for themselves!

• 30 – 40% Increase in Operational Efficiency – Intelligent Automation automatically processes routine customers’ requests, like password reset, product brochures, procedures, account statement and premium paid certificates which in turn improves operation efficiency manifold times.
• 10% Quarterly Growth – The automated response repository grows every quarter due to self-learning feedback feature. This further offers speedy resolutions to customers’ queries.
• 20% Reduction In Labor Costs - A huge relief to insurers

The Takeaway