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4 ways innovators are using AI in insurance claims

Artificial Intelligence (AI) has piqued the interest of business leaders across all industries in recent years. It is projected that by 2020, the overall AI spend will reach an all-time high of $47 billion. Although the insurance industry has been slower in adopting AI into its processes and operations, there is a definite appetite to accelerate that adoption. According to a recent Accenture survey, 63% of senior insurance executives believe the industry will be completely transformed by intelligent technologies, while 67% say AI will be critical to their organization’s ability to differentiate itself in the market.

Top carriers are already making the leap to utilize AI in insurance claims processes. The remainder of this post explores the different ways that AI is impacting, and will continue to impact, the insurance industry by expediting the time it takes to process claims, incorporating chatbots, using AI to monitor and prevent fraudulent claims and analyzing data provided by Third Party Administrators (TPAs) to track their performance and efficiency.

Expediting Claims Processing

Filing an insurance claim is both a data intensive and time-consuming process. Multiple employees must be involved to assemble, verify and compute a multitude of data points, making the overall process very complex. Considering the importance of cycle-time, or time-to-settle to insurance customers, according to surveys by JD Power & Associates, it’s critical for insurance companies to speed up the process to stay competitive.

Many companies are starting to use AI in insurance claims processes to tackle this problem and process claims faster and more efficiently. Some common areas in the process where AI can be applied are reporting a claim, assessing damage, and communicating with the involved customer. Liberty Mutual is reportedly working on a mobile app that would allow policy holders involved in a crash assess the damage to their vehicle by taking a picture with their phone. The app would utilize AI trained by thousands of images of car crashes to accurately assess the damage, potentially eliminating a lot of time-consuming steps in the claims process.

Incorporating Chatbots

While there are many innovative AI initiatives in the works for expediting claims, one of the more common vehicles being used today are AI-powered chatbots. Many insurance companies have replaced cumbersome forms with chatbots to more efficiently facilitate the initial data-gathering steps required when filing a claim. As an example, Lemonade reports to have settled a claim in less than 3 seconds with its AI-powered chatbot.

But for the majority of claims, AI-based speech analytics solutions like Tethr can provide a deeper understanding of how chatbots and customers interact. This analysis can surface suboptimal experiences in phone or chat interactions that can then be used to better train the chatbots, further cutting back on claims processing time and tasks that require live agents. These insights can also be used to track customer preferences, predict future customer needs and flag potentially fraudulent activities.

Detecting and Preventing Fraud

Fraudulent claims are a major problem for insurance companies, costing the industry an estimated $40 billion per year. This enormous expense is amassed from duplicate claims, false claims and identity theft through activities like phishing. The variance in how these fraudulent activities can occur makes it challenging to both detect when they occur and design policies and procedures that prevent them in the future. This is an area where insights generated by AI-based speech analytics solutions like Tethr are helping.

With AI-based speech analytics, insurance companies are able to identify key words and phrases used in claims interactions that are indicative of fraudulent activity. This enables companies to quickly flag instances of potential fraud for review while continuously surfacing insights on fraudulent conversation patterns that better enable agents to prevent future fraudulent claims from occurring.

Enhancing TPA Transparency

Third Party Administrators (TPAs) provide a variety of services to the insurance industry like claims processing, risk management, billing, and in some cases call center services. Like Business Process Outsourcing (BPO) firms in the service space, TPAs are utilized by insurers for outsourcing laborious tasks. TPAs often represent the client brand directly with customers when handling claims. When a TPA agent creates a positive customer experience, the insurance company’s brand benefits. However, the opposite is also true. TPAs have the power to damage an insurance brand by providing a poor customer experience or processing claims inefficiently. For this reason, it’s critical for insurance companies to be able to track how TPAs are interacting with their customers during the claims process and measure how those interactions affect key customer experience metrics.

AI-based speech analytics platforms, such as Tethr, can analyze, track and continually monitor what’s happening on the calls TPAs are having with customers. With this technology, insurance companies gain visibility into whether TPA agents are using the correct language or are following the prescribed script. It also quickly surfaces gaps in the claims experience that companies can then quickly solve for. With this visibility into 100% of their customer calls, insurance companies are much better enabled to manage TPAs and ensure they are representing the brand in a positive way.

This is just the beginning of the impact that integrating AI in insurance claims processes is having in the rapidly evolving insurance industry. If you’re investing in AI for insurance claims and are interested in incorporating speech analytics into your strategy, contact us to learn more about how Tethr can help!

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