One of the most significant issues in an insurance claim is that of complexity. What often starts as a mundane, simple claim submitted by an insured that later ends up in litigation can be stressful, time-consuming and costly. Often, Claims Managers, Supervisors and Senior Examiners are rapidly inundated with high volumes of data generated from complex claims. Unfortunately, most of the data leading to critical insights are in the form of “unstructured text.” As a result,
the assigned Examiner will not discover the necessary information needed to investigate or resolve the claim effectively. In addition, time sensitive issues such as demands from attorneys trigger critical deadlines during the claims process. If these deadlines are ignored or missed, the cost to resolve the claim will be higher. So, how can you efficiently and effectively process complex claims and lower associated costs? The answer is artificial intelligence (A.I.) generated
Artificial intelligence is the ability of a digital computer or computer-controlled robot to perform tasks commonly associated with intelligent beings. Merriam-Webster defines artificial intelligence as “a branch of computer science dealing with the simulation of intelligent behavior
in computers, or the capability of a machine to imitate intelligent human behavior.” 1 Two powerful components to A.I. are machine learning (M.L.) and natural language processing (N.L.P.). The N.L.P. in an A.I. solution for insurance claims and underwriting is crucial when deciding on a software program. By utilizing this powerful technology, the otherwise hidden patterns in claims data can be revealed to the claim handler, thereby avoiding high severity and
potential litigation. How can you find these hidden patterns? The answer is within an A.I. solution with M.L. and N.L.P.
Charlee™ – The First Insurance Insights Engine for Claims and Underwriting
The Infinilytics Team created Charlee™, the first Insurance Insights Engine for claims and underwriting.2 Charlee™ was trained on over 40 million claims and has 40,000 pre-built insights for personal and commercial automobile, homeowners, commercial property, and the general liability lines of business insurance.
The power of Charlee™ in discovering the hidden patterns in claims data and how A.I. and M.L. and N.L.P. can lead to the mitigation of high severity and potential litigation in complex claims. The benefits of Charlee™ are claims historical results, benchmarking, litigation prediction, suspected fraudulent claims, real-time insights, and alerts Charlee™ acting as a cyber supervisor, assisting all to achieve efficient and effective claim assignment and resolution.
Complex claims usually involve things such as multiple parties, product defects, severe and disabling injuries, co-insurance coverages, high dollar amounts, government agency involvement, multiple insurance periods or questionable language and terms in a policy. Mountains of data in the form of claim documents such as investigation reports, appraisal and estimates, witness statements, third-party data, and relevant documents are the common denominators in complex claims. It takes time for a senior claim examiner to read, analyze, and prepare a course of action to process and resolve the claim. The Charlee™ Insurance Insights Engine automatically analyzes the structured and unstructured text in all these documents, identifying patterns and insights for the examiner to review.
The benefits of Charlee™ are:
● Claims historical results mapping
● Litigation prediction
● Suspected fraudulent claim alerts
● Real-time insights
● Alerts (Charlee™ acting as a cyber supervisor)
Imagine the Possibilities
Imagine the possibilities of lowering claims costs, reducing the severity, and avoiding litigation at the First Notice of Loss for a claim. Moreover, imagine how the A.I. generated insights by Charlee™ can assist your underwriting team in identifying and managing risk in the portfolio.
Contact Infinilytics today and learn how Charlee™ can help your claims and underwriting teams.