No claim left behind

In the 29 seconds it took President-elect Donald Trump to take oath, our AI Agent accomplished four tasks: (i) Extracted relevant info from a certificate presented by a claimant (ii) Cross-validated the info by scanning the QR code of the appropriate government database (iii) Reconciled with the handwritten claims form presented and (iv) Delivered a go / no-go decision to approve the claim. This we did for a 66-million-member-strong life insurer, rapidly expanding their footprint in a market that’s still heavily under-penetrated. God bless AI.

If your department is just as determined to govern efficiency, our AI orchestration platform is a good one to check out. BFSI, healthcare staffing, patient routing, personalized education, supply chain management, retail, fashion… the Vue.ai orchestration platform is modular and highly customizable, powering operators in all these spaces.?

Within the BFSI space, we investigate invoice processing (The Wolf of Invoice Street) and contemplate why credit needn’t always have to chase its tail (Banking on shaky grounds). Loans processing is another ripe domain to benefit from our AI platform (Paperwork and propensity—same old loan game?). We now share our learnings in automating yet another resource-intensive task in the industry: Claims processing.

Claims to fame

Claims management sits at the heart of insurance operations, shaping both customer satisfaction and operational efficiency. A language-intensive process that requires the collection, processing, and analysis of extensive, diverse information (claims forms, medical reports, accident descriptions), navigating these complexities often means confronting inefficiencies, rework, and delays that inflate costs and frustrate policyholders. Could automation present a transformative opportunity to address these challenges?

Start with the complexities

Claims processing is fraught with manual interventions, repetitive tasks, and a reliance on human expertise for validation and adjudication. For instance, processing a single disability claim often entails multiple handoffs between systems and personnel. Companies frequently fail to collect all necessary information upfront, resulting in rework and delays. Such inefficiencies not only slow down payouts but also contribute to declining productivity and increasing operating costs.

Policyholders, understandably, expect swift resolutions. Yet, insurers often struggle to meet these expectations due to outdated processes and fragmented workflows. High levels of rework, unclear responsibilities, and the lack of standardized practices exacerbate the issue. The need for transformation is evident, and automation offers a practical pathway forward.

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Process optimization: Laying the groundwork

Before diving into automation, some foundational process improvement is essential. A detailed analysis of current claims-related processes, for instance, revealed inefficiencies and redundancies. Mapping workflows and identifying non-value-adding activities helped streamline operations before automation is introduced. Standardizing rote, rules-driven tasks created a strong foundation for Robotic Process Automation (RPA) to thrive.

Process analytics played a pivotal role in uncovering the root causes of delays. For example, automatic routing of claims to the appropriate teams can reduce processing time and ensure that the right expertise is applied at the right stage. Core administrative system changes, such as enabling straight-through processing, would further minimize handoffs and reduce manual intervention.

The benefits of these improvements are clear: a significant reduction in handoffs, concurrent boost in productivity, and faster disbursements leading to more satisfied policyholders.

The 7 habits of highly effective AI Agents

From the first notice of loss (FNOL) to the final settlement, automation in claims management can impact the entire lifecycle. The top KRAs we assign to our AI Agent are...

1. Automating high-volume, low-value tasks: Delegate repetitive tasks like data entry, document categorization, and initial validations to RPA; free-up human resources for strategic work.
2. Streamlining information validation: Manual validation is time-intensive, error-prone. Transform this process into a highly accurate and efficient system that reduces the likelihood of mistakes.
3. Fraud detection: Detect inconsistencies across documents, identify potential fraud risks by comparing claims narratives with official records. Minimize claims leakage and ensure fair settlements.
4. Customized claims handling: Build-in flexibility to address variations in the different types of claims (death, disability, or maturity), while improving compliance and avoiding penalties.
5. Enhance triage and decision making: Straight-through assessments for simple claims and tailored triage pathways for complex cases reduce the need for manual intervention and accelerate resolution times.
6. Consistency and accuracy: Use pre-defined rules and automated workflows that ensure standardized assessments, reduced errors and variations in claims outcomes.
7. Data-driven insights: Structured claims data opens up opportunities for real-time dashboards, advanced analytics, and improved decision-making in underwriting and pricing. Over time, these insights enhance overall business performance.

And, so...

Automation is not a one-size-fits-all solution. The most successful implementations are those that align with organizational goals and address specific pain points. Partnering with IT teams to ensure friction-free integration with legacy systems and adopting modular, configurable solutions is essential. Such platforms provide the flexibility to adapt to evolving needs while laying a strong foundation for long-term success.

About:?Vue.ai is an AI orchestration platform that actively caters to enterprises in BFSI, retail, logistics, healthcare and other domains. In the Accounts Payable space, the platform powers an annual throughput of 10 million invoices for Client A, with a data extraction accuracy of >90%.?Details.?While the Intelligent Document Processing feature?(Video; 2 mins)?is among the strong offerings of the platform, Vue.ai also helps BFSI clients use AI to solve challenges such as credit issues, fraud risk, KYC processing, lead scoring, propensity modeling and more?(Video; 45 secs).

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--> AI budgets often sit with the CTO, but as adoption grows, they’ll expand across the organization.

--> Adoption leads to growth, and eventually, reinvention. --> Right now, it’s about building on existing layers, but the future will be about rethinking the entire stack.

--> Focus isn’t just on ROI today—it’s also about building a foundation for a resilient, future-ready ecosystem. Insights from our BFSI Accelerate: Gen AI for Operational Excellence & CX program at Google Cloud. Featured speaker: Arun Raghavan, SVP, IT & Digital Strategy, Star Union Dai-Ichi Life Insurance Company Limited

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