Filed Under:Carrier Innovations, Technology Solutions

Using AI and automation to transform claims handling

Improvements in software and artificial intelligence can now apply to insurance

High expectations for customer service during the insurance claims process highlight the importance of handling claims quickly and efficiently. (Photo: Shutterstock)
High expectations for customer service during the insurance claims process highlight the importance of handling claims quickly and efficiently. (Photo: Shutterstock)

The concept of straight through processing (STP) has been used in the financial services market since the ‘90s. The idea is to reduce the need for human intervention and create fully automated business workflows that speed up transactions.

Thanks to improvements in software tools and artificial intelligence, STP can now apply to insurance claims because it enables carriers to be responsive, reduce the risk of errors, cut costs, and process claims faster. Automation combined with AI enabled start-up insurer, Lemonade, to process a claim in just three seconds last year. Let’s take a closer look at some of the problems STP can address.

Manual processing

Carriers are under pressure to reduce costs, but manual claims processing is time-consuming, labor intensive, and fraught with the risk of error. There are bottlenecks that slow progress down, hand-offs between siloes, and disparate systems and databases to search and collate. A single policy might necessitate data exchanges from multiple agencies, carriers and other third parties. Due to incompatibilities between IT systems and siloes, that data is often manually re-keyed.

When inaccurate or incomplete data is discovered, communications can take several days to pass from adjusters to agents to customers and then back again. The result is a slow process with limited transparency for the insured. For carriers, it is expensive, and every manual task and transition introduces an opportunity for error.

Related: How to calculate deductibles for multiple related losses

 man demonstrating artificial intelligence

Technology is allowing insurers to quickly capture information at first notice of loss and expedite the claims process for policyholders. (Photo: iStock)

The potential power of AI

Artificial intelligence (AI) has improved dramatically over the last few years and is having a tangible impact on many industries. A full 75% of 550 insurance executives surveyed by Accenture said they believe that AI will either significantly alter or completely transform the overall insurance industry in the next three years.

There are several ways AI can improve STP according to PwC’s annual Top Insurance Issues Report for 2017. Robotic process automation (RPA) can automate data entry and validation, track compliance and standards, and streamline processes. Machine learning can provide insightful analysis and predictive modelling. There is even an opportunity for AI to assist with the looming skills gap, with 61% of carriers reportedly exploring the benefits of humans and machines working together.

Removing as many manual steps as possible will be beneficial. Taking steps towards automation and leveraging AI also frees up skilled adjusters to utilize their experience where it adds the most value. AI can help eradicate repetitive manual tasks and establish consistency. With machine learning and the right metrics in place, it is also possible to create a self-improving system.

Related: From FNOL to settlement — data matters

diagram of how claims information can be shared between multiple parties Customers want transparency throughout the claims process and an efficient resolution of their insurance claim. (Photo: iStock)

Using STP

Expectations about service are changing rapidly with the rise of a customer-centric, always accessible approach. Customer service is growing more and more important, and customers can easily switch carriers if they have a bad experience.

In Accenture’s Customer Service Survey, the top two key contributors to customer satisfaction with the claims experience were speed of settlement, which 95% of respondents said was important or extremely important, and transparency of the process, which 94% of respondents felt was important or extremely important.

STP can shorten claim cycle times since the standardization of customer data reduces the risk of error and ensures that everyone receives a consistent level of service. By automatically collating data from disparate sources and applying the same logic, STP systems can handle straightforward claims.

This means using technology to automate the processing of contents claims from start to finish, requiring no human intervention from insurance carriers. Once users submit their inventory, a proprietary rules engine scores the contents for fraud and fast tracks eligible claims for instant payment settlement. Automated updates can keep customers fully informed at every stage of the process.

When specific criteria is not met, it can trigger a query that may automate further investigation, spark a request for customer input, or command the attention of an experienced adjuster. With time-consuming, repetitive tasks eliminated, carriers can cut labor costs per claim and reduce the number of errors, all while accelerating the overall process.

Joel Makhluf is a vice president at Enservio and the director of the Property Innovation Summit, one of the insurance industry’s premier thought leadership conferences. Enservio is a provider of contents claim management software, payments solutions, inventory and valuation services for property insurers. Contact him at

Related: 5 dated insurance business tools, technologies

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