Smart Claims
Smart Claims is a claims automation solution. It uses artifical intelligence (AI) modelling to replicate the insurance expert's decision-making, enabling claims to be processed in real-time, while providing necessary risk.
Transforming the Claims process
The intelligent automation of claims decisions by securely integrating the relevant internal and external data, and enables the straight through processing (STP) of insurance claims. Alula offers Life Insurers the opportunity to re-imagine their underwriting process with intelligent automation.
The Business Challenges
- Human-driven decision-making at different levels creates a slow and inefficient claims process.
- Data used in the decision-making process is manually collected, which is time-consuming and inaccurate.
- External data is seldom used to verify the validity of internal data and claims.
- Consolidation of multiple data sources presenting a single view of your data.
- Different individuals involved in decision-making create inconsistent and potentially error-prone decisions.
- 10% of claims are fraudulent but 100% of customers are treated as suspicious claimants which creates a poor customer experience.
The Solutions
The Smart Claims solution includes internal and external risk score and intelligent decision-making which enables the straight through processing (STP) of insurance claim.
The solution present with the opportunity to improve customer experience whilst mitigating risk. The solution improves business efficiency, allowing staff more time to attend to higher value tasks.
How It Works
The Smart Claim solution integrates directly into insurance line of business system, as well as all other third party data sources used for claims decision-making.
The AI modelling process virtualises expertise of the best decision-making at an insurer there ensuring expert attention can be given to every claim processed within the organisation. These models are continually assessed to ensure they make the best decision possible. They can quickly be retained and redeployed in the reaction to market changes with no impact on existing business processes.
Smart Claims Process
Benefits
- Better claims decisions are made while border risk and ethics are taken into account
- Decreased pay-out of fraudulent claims
- Improved accuracy due to a fully automated process which eliminates the risk of human-error by 100% on standard claims
- Enhanced customer experience
- Improved focus and optimization of insurance expects time
- Commercial, business risk, and ethics are considered in all underwriting decisions
Features
- Straight-through processing (STP)
- Multiple sets of internal and external data can be used simultaneously in decision-making
- Records and stores consumer consent - Data Privacy Regulations
- Manages a plurality of integrated data sources, whilst ensuring stability and security of all data exchanged.
- Real-time insught from multiple experts within the business (underwriter, compliance, legal etc.) can be applied to all new applications
- Exposes outward facing APIs for data distribution and Health Score dissemination
- Flexibility to add different data sources and connection to new business workflows and administration systems