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AI and Automation improve Claims Management

Business Challenges

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.

Solution Summary

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

Value Delivered

  • End state savings of more than 75%, that includes process, design, automation, right shoring and business model change.
  • Paper claims reduction by 55%
  • Increase in Auto-adjudication by 65%
  • Error and rework reduce below 5%
  • One Day Pay increased by 40%
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