Smart Claims

Challenge  

• Automating claim coverage determination by comparing claims documents to contracts is challenging due to linguistic nuances, distributed conditions, and dynamic claim lifecycles
• High semantic accuracy, low-latency responses and preventing leakage from blanket approvals of threshold-based claims were crucial requirements

Solution  

• Developed a robust solution leveraging GenAI that accounted for contract intricacies, dynamically updated claim lifecycles, and ensured semantic precision
• Exposed TypeScript functions and connecting to Azure for orchestration, balancing speed and scalability
• Automated evaluation of threshold-based flow claims by dynamically analyzing contracts & claims documents

Results  

• Significantly reduced leakage by preventing blanket claim approvals, saving the organization 20M+ USD
• Enabled automatic review of claims traditionally falling under threshold-based acceptance rules.
• Showcased a transformative impact with claims experts estimating a return of 10-100x.