Global firm lifts lid on automated claims solution

Global firm lifts lid on automated claims solution | Insurance Business Australia

Global firm lifts lid on automated claims solution

“It is one thing to solve a problem through our solution, but I would ask, are you even solving the right problem? That’s where the rubber hits the road,” said Abhi Bhola (pictured above), EXL’s APAC vice president of sales for insurance business.

Bhola said key insurers in Australia see EXL - a global data analytics and digital operations and solutions company - as a partner to accelerate data-led digital transformation with strong insurance domain knowledge. Melbourne-based Bhola believes that distinction is very important.

“This is something EXL strongly believes in. So, it’s not just technology for the sake of technology, it is not just digital for the sake of digital, it is data led thinking and digital as a business model. One of the sectors that is making it all real is the insurance space,” he said.

The last five years of expansion in the Australian market, Bhola said, have hinged heavily on the market appreciating EXL’s commitment to data-led digital transformation “with a very insurance centric lens.”

“Insurance has been a key industry sector for EXL for the last two decades and we’ve collected deep domain understanding,” he added. 

The company partners with insurers to help them gain a competitive advantage with efficient and sustainable operating models through the use of AI and digital, insurance domain expertise and advanced analytics. EXL says it provides solutions to the fundamental questions insurance companies are asking about their end-to-end operations including claims. 

“How are we ensuring that my [the insurer’s] whole claims process is optimal in nature and working as it should be? Right?” said Bhola.

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One of EXL’s offerings helps insurers automate the end-to-end quality process in their claims operations.

“What we have is an AI-powered automated claims quality solution to drive consistent and compliant claims operations for better customer experience and for preventing any financial leakage,” he said.

“What it helps insurers do is intake all the claims information, whether it was a claims call that happened, or through the claims file notes, prepared by the claims agent and analyse it against a standard set of rules and provide a quality score,” he said. 

Bhola said this is powerful because in manual quality audits the coverage is only 10-15%, whereas with this solution insurers can audit almost 100% of their claims.

“If it’s a manual process there is only so much one person can measure, right? With automation you can analyse 90 to 95% of that information which means you’re able to understand what customers are saying, what is happening in the claims process and then take proactive action if things aren’t heading in the right direction during the claims process,” he said.

This claims solution, said Bhola, helps to automate quality reviews based on the insurer’s own quality parameters. “Those parameters could include aspects like timely customer communication, correct supplier payments, proper coverage verification including many other factors,” he said. 

Depending on the size of the insurance company and their claims quality process, he said, there could be a few hundred to a few thousand manual checks in place which could be automated using this solution.

The solution, Bhola said, provides a quality score either at the parameter level, or audit level, or to the entire claims chain providing comprehensive visibility in an easy actionable way.

“What that means and where this is powerful is that your approach, in this case the insurer, is changing from reactive to proactive,” he added.  

Bhola said one way this solution can be particularly useful is to help insurers understand and identify claims issues early on that might possibly escalate to a complaint later.

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“If, during a claims process, there are multiple types of claims and not all the claims outcomes are what people are expecting, or the experience is not what people are expecting - but if, during the early stage of the claim, the system can actually give you an idea that there is something here which is low score that can possibly lead to a complaint, you may want to flag it and see how you want to fix it,” he said.

Bhola said an insurance agent can then take corrective action or at least have another look at the claim and the issue.

“What has happened is that you have captured the information and you’ve got the data point in your hands to actually make that informed judgement,” he said.

Bhola believes claims solutions like these set EXL apart from the competition.

“I believe so. This is very different because this is insurance-led and the investment in the AI models in there is based on the way we used to manage quality operations. It’s something that a lot of insurers locally are showing an interest in,” he said.

However, he said it’s not the only trick in EXL’s claims operations model.

“Our solution for claims intake is another strong area where we use AI/ML-driven content extraction particularly on turning unstructured into a structed data format like in claims notes. It is not only solving the efficiency problem, what it is also doing is giving you precious amounts of new data that you were not earlier looking at - and imagine what you can do with that data,” he said.