Improving claims to death

My first lesson during my early days in Life Insurance was that death is the only predictable end in this world. I have shared a very interesting website link in my post, it was recommended by a re-insurer in 2001 ( You'd expect a re-insurer to know about these things, even in jest) and apparently the website engineers are still working on the precise algorithm.

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The insurance industry has never really been a guiding light with matters related to Technology in the Financial Services domain. Insurance companies have albeit, taken inspiration from non insurance brands like Amazon to transform and improve the Sales & Distribution experience. Hence the capital investment and operating budgets have paid more cognizance to improving the distributor's experience. In fact some of the top Digital Insurers using Insurtech solutions for Sales & Distribution like Acko General Insurance based in India, BIMA, a Sweden based company that has 26 million customers from the low income families across 14 countries and of course, Lemonade based out of US are all companies to watch out for in the Insurance disruption space.

Customers have benefited in terms of ease of access and quicker processing of their applications. General Insurance companies have many true online products where a large majority of the consumers are completing the entire on-boarding journey online, without any intervention from a call-centre,Barring a small percentage of consumers who buy and process their policies online without human intervention at a go, Life Insurers in India, by and large still need to resort to call center staff to assist an online sale (either owned by the Insurer or the web-aggregator) or have a waiting queue for verification of uploaded documents for their 'online' Policy Issuance process.

So far, most of the transformation in the back-end operations processes largely included deploying or upgrading business process management systems, Auto Underwriting engines, a well rounded CRM solution, a Virtual Reality Customer Service Portal, an Automated Claims Rule engine, a dependable MIS solution like SAS (the bigger insurers already have Data Lake for data integration)  and at the most a Fraud Analytics detection Tool. However the fact is that there are rapid developments and inventions happening in our world everyday and we must continue running to keep up with the pace of change in technology and customer expectations. More than one General Insurance company in India has already deployed Blockchain for its Travel Claims. When we look around the world embracing reinvention and transformation, it is only the tip of the transformation iceberg.


There was a time when parents imposed strict discipline on their children,this was long before the treat-your-child-as-an-adult days. That was the era when young adults were fearful of their parents finding out about their newly acquired smoking or alcohol habits. In some parts of our society, this discipline is relaxed and hence discipline is now imposed by advanced technology. The Canada based, Sensor Diagnostics has developed an in-car sensor solution to prevent drunk driving, aptly called Sober Steering. The bio sensor pad is installed on the surface of the driving wheel and synced with the interlock of the wheel. The sensor detects the blood alcohol concentration based on the gases exuding from the palm. The driver has to place the palm on the Sober Steering wheel that alerts the driver when he or she is drunk and if the alcohol exceeds the safety limit, the safety lock comes into play and the vehicle is immobilized. This vehicle lock-down continues until the alcohol influence is found to be negative by the sensor. Interestingly the solution was developed for school buses to ensure that the bus driver were not driving children while under the influence.


The Paris based Shift Technology uses its AI native solution to offer Software-as-a-Service model (SaaS) and uses data science to detect network of fraudsters in Insurance. It claims to have a 75% hit rate in terms of separating the true positives with the false positives. Their FORCE solution provides contextual guidance to enable Claims investigators and is slowly gaining popularity in Asian markets.  Their experience is the different continents they work in has helped them to bench-mark the fraud landscape of different nations. In one of the pilots which eventually became a permanent client for them, after 12 months of collaboration, the client received nearly 3,000 alerts. FORCE maintained a consistent hit-rate of around 80%, implying that 80% of all fraudulent alerts sent were deemed suspicious by the local fraud handlers.


As Mary Leod Bethune had wisely said, The whole world opened up to me once I learnt to read. I wonder what the First Lady of African American struggle would say were she alive to see that roughly 60 years after her death, the intellect and analysis required to read is programmed into an app by Botminds, an AI company founded in Seattle.

Botminds has an interesting AI solution that aids the Claims process in a very transformative way. This solution has the power to bring down the time taken for Claims assessment. The app AI has the capability to read different types of very long documents with structured or unstructured data, structure them, summarize them and produce an extract that is comprehensive to enable the Claims assessor or the Claims rule engine to take a final decision. The app collects and records every small detail and uses machine learning to learn if any of the factors are different from earlier samples.

Imagine the time that can be saved in deciphering & summarizing a First Information Report to a granular level without any human intervention, the tool is multi-lingual and produces an extract of all the required information in a structured manner. The app is being utilized by progressive legal firms to enhance the band-width of teams where time is money and counted per hour.The Botminds app enriches the extracts from other documents and stores them as training data. For instance, if a particular medicine is priced differently in different bills, the app has the 'good sense' to highlight this difference and over a period of collecting similar training data will give the Claims assessor an indicative price of the medicine.In fact the AI tool builds on the training data has the super-ability to even predict the Claims decision.


We are in the business of paying claims. An intimation of claim is the moment of truth of an insurer. The Insurers are working hard to make this moment as smooth and quick as possible.The sensitivity of the situation requires a very high degree of emotional intelligence while speaking with the claimant on the telephone. The Claims assessor may not always be physically available. Some companies have trained Specialist Claims Relationship Managers, some have trained their local field staff, a few have deployed Automated Claims engine to tackle a larger number of cases. For instance, a health or death claim is still an area that is worked upon manually with multiple iterations. A Death Claim assessment requires more attention depending on whether it falls within the 3 year Indisputability clause or otherwise. Paying any Insurance claim tells a story about whether or not an insurer kept its promise to take care of its customers during a time of crisis.

There is a dichotomy where Insurers aspire to render customized Claims service for the customer and want straight through processes for a large number of their claims cases. Customers in general tend to distrust insurance companies and as a result present unique challenges for the Insurer. Introducing Technology solutions for Claims will aid the insurer to create a brand image that cares for customers and is using Automation for all the right reasons. If we could truly determine the exact time and date when we would be facing our inevitable end, that is when Insurance will achieve its ultimate level of transformation and deliverance.If happens to become miraculously accurate, it would be the doomsday for Life Insurance business as well.


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