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Embracing AI in life insurance claims process

By Patrick Ashton, Head of UK operations, Alula Insurance Technologies

Patrick Ashton, Head of UK operations, Alula Insurance Technologies.
Patrick Ashton, Head of UK operations, Alula Insurance Technologies.

Managing claims is a core business process for any insurer. It is also one of the most time-consuming areas that requires customer verification, validation of claim details and the management of the authorisation and payment release processes. Claims automation solutions can be an essential enabler to help streamline processes, reduce manual effort and improve the speed, accuracy and consistency of claims.

Typically, data used when making decisions on claim payouts is collated manually. Not only is this very resource-intensive, but it is also prone to human error. Furthermore, external data sets are seldom used to verify the validity of internal data and claims that often result in incorrect or inaccurate decisions being made.

Another challenge when it comes to traditional approaches to claims is that different individuals within the business are involved at virtually every step of the process. This can result in inconsistent and potentially error-prone decisions as well as massive inefficiencies within the business.

Intelligent automation

Claims automation provides a more effective way of overcoming these obstacles. It can be defined as solutions that automate various aspects of the claims process, such as data capture, validation and processing. By replacing manual processes with this more automated approach, insurers can reduce the number of human experts required for administrative-intensive tasks.

In line with this, Alula has introduced its Smart Claims solution. This claims automation solution uses artificial intelligence (AI) modelling to replicate the insurance expert’s decision-making, enabling claims to be processed in real-time, while providing the necessary risk oversight. This digital twinning is considered the next evolution in the claims automation process.

Next evolution

It replicates an insurer’s underwriting, claims, compliance and legal teams’ expertise. It learns – and continues to learn – the decisions that they would make, freeing them up from the business-as-usual tasks so they can focus on applying their expertise on higher valued tasks within the business

These AI models are continually assessed. This ensures they are capable of making the best decisions possible, every single time. The smart claims solution injects real-time insight from multiple experts such as the underwriting, compliance officer and legal department and applies that to every claim submitted. The models can also be retrained and redeployed in reaction to market changes with no impact on existing business processes.

Alula’s Smart Claims solution integrates and automates the expertise, data and rules engines of the insurer with other third-party data sets, in real-time. This results in improved decision-making that is done faster and with greater accuracy than what was previously possible where human decision-makers are involved.

Despite global or local disruptive events, which may affect human movement and delay their ability to timeously make decisions, the automated processing of claims continues securely and efficiently regardless. Claims automation also provides insurers with the means to apply more consistent claim decisions while still accounting for broader risk and ethical considerations. By improving claim decision accuracy and timeliness through these automated processes, the customer experience will also naturally be enhanced.

Following its successful introduction in South Africa, the Alula Technologies Group is expanding the Smart Claims solution globally and has recently launched it in the UK and UAE markets. In this way, Alula is creating the opportunity for insurers to re-imagine their claims processes using advanced automation technologies that incorporate AI.

Alula Technologies Group

The Alula Technologies Group provides business critical solutions to Life and Health insurance companies. Our solutions modernise policy administration, digitalise policyholder and channel engagement, and intelligently automate key insurance business processes. We also integrate first and third-party data, including health and wellness data, to drive more efficient operations, improved policyholder experiences, and a better understanding and management of risk.

Editorial contacts
Rubicomm Gloria Malan (+27) 82 340 2876

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