Smart Claims

Developed an advanced AI solution determining complex claim coverage by comparing documents to contracts, preventing significant leakage.
Details
Service Offering
Implementation
Industry
Insurance
ROI
Reduced claim leakage
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
  • Enabled automatic review of claims traditionally falling under threshold-based acceptance rules.

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