Sprout.ai uses a number of AI models to automate all or any part of insurance claims processing. Unlike general-purpose AI models such as Chat GPT, Sprout.ai has been specifically built for claims, with a focus on real-time data processing, fraud detection, and policy checking. It acts as the brains behind the scenes, helping claims handlers work efficiently, effectively, and with a focus on serving customers.
This blog sets out how Sprout.ai uses AI, and what differentiates its AI from other AI models you already know, such as Chat GPT.
How Sprout.ai uses AI
When Sprout.ai processes a claim, it goes through three stages:
Understanding unstructured inputs
Sprout.ai begins by processing unstructured inputs, such as documents and images, using computer vision technology. OCR (Optical Character Recognition) technology extracts relevant information from these documents, including PDFs, images, and handwritten notes. This capability is essential for handling unstructured data, which traditional systems often find challenging.
Contextual analysis
Next, the system interprets the extracted data within the context of the insurance policy. It uses Natural Language Processing (NLP) techniques to identify key information, such as the claimant’s identity, ensuring that the data is accurate and relevant. This real-time data analysis allows insurers to make informed decisions quickly, reducing the average claims processing time from weeks to less than 24 hours, thus improving customer satisfaction.
Decision making
Finally, the AI uses the processed and contextual data to make decisions about the claim, including determining coverage and calculating payouts. This decision-making process is guided by machine learning (ML) algorithms, which continuously learn from new data to improve their accuracy. These algorithms help identify patterns in claims data, predict outcomes, and enhance fraud detection capabilities.
Automatic validation
At every stage, a feature called “automatic validation” helps ensure the accuracy and legitimacy of claims. This sets confidence thresholds to automatically process claims that meet certain criteria.
Additionally, it performs common-sense checks to verify the validity of the information provided. For example, if a dental claim is submitted without the claimant’s name, the system can identify this discrepancy and flag the claim as potentially invalid, removing it from the automated process for further review.
How Sprout.ai integrates with existing systems
Sprout.ai can be used to automate claims processing from end-to-end, or just certain elements of it, such as extracting relevant information from documents or policy checking.
In either case, it acts as an intelligence layer that integrates seamlessly with existing claims management systems. It receives updates from these systems, processes claims, and returns actionable results. These can then update certain fields or trigger a recommendation.
It doesn’t change the interface claims handlers use, so very little training is needed to start working with it. However, there is always the option to explore the rules-based reasoning behind AI-driven decisions, and obtain insights about them.
What differentiates Sprout.ai from GPT and other general-purpose AI models?
Sprout.ai uses AI to optimise the insurance claims process.It differs significantly from AI models like ChatGPT. Here’s how:
1. Specialisation
– Sprout.ai: Specialises in insurance claims processing, focusing on extracting, validating, and analysing data specific to this domain. Its technologies are tailored to meet the unique needs of the insurance industry.
– GPT: A general-purpose language model designed to generate human-like text. It can perform a wide range of language-related tasks but is not specialised for any specific industry.
2. Functionality
– Sprout.ai: Uses OCR, NLP, and ML to automate document processing, validate claims, detect fraud, and provide real-time data analysis. Its primary goal is to streamline and enhance the insurance claims process.
– GPT: Primarily used for generating text, answering questions, and translating languages. While it can assist in various applications, it does not have the integrated capabilities needed for complex, industry-specific tasks like claims processing.
3. Real-time processing
– Sprout.ai: Focuses on real-time data extraction and analysis, enabling insurers to process claims swiftly. Its AI technologies are designed to handle real-time demands efficiently.
– GPT: While capable of real-time text generation, it is not inherently designed for real-time data extraction or complex multi-step processes required in insurance claims handling.
4. Fraud detection
– Sprout.ai: Incorporates advanced fraud detection mechanisms that analyse data patterns to identify anomalies and potential fraud. This helps in reducing fraudulent claims and associated costs.
– GPT: Does not have built-in capabilities for fraud detection. It can assist in generating responses or analysing text but lacks the specialised tools for detecting fraud in insurance claims.
How Sprout.ai processes a claim
Document processing: It extracts and processes information from a variety of documents, such as damage assessments and repair estimates.
Contextual understanding: It validates extracted data against policy terms to ensure accurate claim assessments.
Fraud detection: It detects anomalies and potential fraud in claims data.
Real-time analysis: It facilitates quick decision-making by providing real-time data analysis.
What can Sprout.ai do for you?
- 48% cost reduction in claims operations
- $21 cost reduction per claim, across millions of claims annually
- A 50% increase in claims automation, allowing claims handling teams to focus more on customer interactions and complex cases
- Over 30% capacity increase, boosting productivity for handling simple, medium, and complex claims
- A reduction of 22 days in claim duration, resulting in faster processing times with higher accuracy, leading to quicker resolutions and improved customer satisfaction
Conclusion
Sprout.ai uses AI to transform the insurance claims process, making it more efficient, accurate, and customer-friendly.
Unlike general-purpose AI models like ChatGPT, which focus on language tasks, Sprout.ai is tailored specifically for the insurance industry. It handles unstructured data, performs contextual analysis, and aids in decision-making, including fraud detection. These features allow for real-time data processing and quick decision-making, significantly speeding up claims processing and improving customer satisfaction while reducing operational costs.
