In order for an insurance policy to pay the benefit under a particular type of insurance coverage, the policyholder (or claimant) has to make a formal request for payment to the insurance company. The formal request takes the form of an insurance claim form requesting payment of covered expenses, such as building repairs or doctor bills. The policyholder or claimant usually sends the claim form to the insurance company in writing. In today’s digital environment, a claimant may file a claim online, over the phone, or with AI.
The following paragraphs provide a brief introduction to the insurance claims process, and how artificial intelligence technology in the insurance industry will affect the industry’s claims processing procedures.
Q1: How Does an Insurance Claim Work?
Several steps comprise the insurance claim process. First, a claimant files a formal claim to the insurance company. Next, claims adjusters interview witnesses, conduct records research, and look at:
- Structural damage to buildings
- Bodily injury in relation to people
- Property damage in relation to personal property
After the insurance claims adjuster conducts the research, the insurance company either rejects the claim as not covered under the policy or validates the claim and submits it for approval.
Once the home office approves the claim, the company pays the insured or an interested party (such as a billing entity, a hospital, or a doctor) that the insured designates to receive the payment on their behalf.
Q2: How Is AI Used in the Insurance Industry?
Artificial Intelligence (AI) changes the way insurance companies underwrite policies, adjudicate claims, market their services, and provide excellent service to their customers. A critical impact is the way AI helps insurers turn big data into business intelligence. For example, machine learning helps insurance companies avoid risk, predict losses, and adjust premiums accordingly. AI also helps reduce fraud and makes claims management more efficient through technology like Blockchain.
Unstructured data, such as video, images, audio, text messages, and social media provide a variety of new data sources. AI analyzes the big data collected from these various sources much faster than its human counterparts can, and AI recognizes complex patterns more efficiently.
In addition, by automating time-consuming repetitive tasks, insurance investigators can concentrate their efforts on cases that score particularly high.
Q3: What Is the Future of AI in the Insurance Industry?
Insurers and customers alike have interactions with interactive agents as insurers look to AI to perform repetitive tasks. Insurers may move more toward augmented reality and virtual reality to visually inspect buildings or other property damage after the insured initiates a claim. Or agents may investigate an automobile’s safety attributes before providing the owner with a quote.
Q4: How to Get Started With AI in Insurance Claims Processing?
Advanced conversational AI provides the complete solution to intelligent automation to make your claims process more efficient. Conversational AI is the technology that empowers computers to understand human language. Developers designed advanced conversational AI to:
- Interpret different languages
- Understand the context of the conversation
- Ascertain the appropriate response
- Respond in natural language
Designers developed advanced conversational AI for high contact industries like the insurance industry. Gartner predicts that such businesses can automate 85% of customer interactions. The platform interacts with customers via email, apps, SMS, and more. The platform uses conversational AI and intuitive business processes to better automate workflows by understanding what people want the system to do and what to do next.
End-to-end automation features the following:
- Visual builder
- Powerful data extraction
- Integration with Salesforce, ServiceNow, and legacy systems
The key to the platform’s success is to understand your demands and your customer’s needs. The automated platform also reduces pending claims backlogs.
During the COVID-19 pandemic, Tower Insurance partnered with Ushur to smooth its transition for remote workers, relying on the platform’s dependability and flexibility in customer engagement. This platform is, in fact, the first micro-engagement SaaS platform that automates business workflows using advanced conversational AI, machine learning, and includes vigorous APIs and user-friendly drag & drop tools.
We invite you to contact us today to speak with one of our industry experts to schedule a free demonstration of Usher’s AI insurance claims process. We look forward to demonstrating how Usher’s AI insurance claims process can help you grow your business.