Processing complex insurance claims can be a daunting task for claims handlers. Traditional methods are often slow and prone to errors that lead to fraud, waste or abuse.
Sprout.ai’s advanced AI technology revolutionises this process. It can be used to process all of the claim, or some parts of it, such as document review. It seamlessly integrates with existing systems, requiring minimal training, for a smooth transition to enhanced claims management. This not only makes claims handling more efficient but also more reliable, benefiting both insurers and customers.
Let’s take a closer look at how Sprout.ai can enhance the handling of complex claims, such as a multi-vehicle accident and a house flood.
How Sprout.ai processes a multi-vehicle accident
A multi-vehicle accident occurs on a busy motorway involving five cars, two lorries, and a motorcycle. It results in severe injuries, extensive property damage, and potential environmental contamination.
Sprout.ai can significantly streamline the claims process. It would take claims handlers working manually days to sort through the claims documents and check them against policies. Sprout.ai can do it in seconds.
Here’s how that works in detail.
Data extraction and initial processing
Sprout.ai uses optical character recognition (OCR) and natural language processing (NLP) to quickly extract relevant information from diverse documents such as police reports, medical records, and repair estimates. It can process images, handwritten reports, and hundreds of languages.
Read more: Did you know Sprout.ai can process claims documents in over 100 languages, from Japanese to Greek?
For instance, it extracts key data from a handwritten statement from a lorry driver and images from traffic cameras, which could otherwise take hours for manual review. This speed and accuracy help insurers quickly understand the scope of the incident and initiate the claims process.
This reduces the time spent on data assessment and entry and ensures accuracy and completeness from the start.
Benefits:
– Speed: Faster initial processing.
– Accuracy: Minimises human errors.
Liability determination
Sprout.ai aggregates data from multiple sources, including police reports, witness statements, weather reports and traffic camera footage. It then analyses patterns to determine potential fault distribution among the parties involved.
By identifying patterns, such as vehicle speeds and positions, it determines the extent of liability for each party involved, streamlining what would traditionally be a time-consuming process.
Benefits:
– Efficiency: Speeds up the liability assessment process.
– Insight: Provides deeper insights into fault determination.
Medical and rehabilitation claims
Sprout.ai extracts and analyses medical records and bills to validate the necessity and extent of treatment. It evaluates long-term rehabilitation needs and associated costs based on medical data.
For example, it cross-checks a claim for physiotherapy against standard recovery protocols, ensuring the claim’s accuracy and preventing inflated costs.
Benefits:
– Accuracy: Validates medical claims against actual treatments and recommendations.
– Cost management: Accurately estimates long-term care costs.
Environmental impact assessment
Sprout.ai extracts relevant data concerning the hazardous materials involved, including type, quantity, and impact. It then analyses potential environmental impacts and necessary remediation steps.
Benefits:
– Speed: Quickly gathers and analyses environmental impact data.
– Thoroughness: Ensures all environmental risks are assessed and documented accurately.
Fraud detection
Sprout.ai detects inconsistencies and potential fraud in claims submissions by comparing data points against typical patterns and historical data. It can spot edited documents and photos.
For example, Sprout.ai detects discrepancies in a claimant’s submission, where the damage described didn’t match the vehicle’s condition. By analysing metadata and historical data, Sprout.ai identifies signs of potential fraud, such as doctored photos or exaggerated damage claims, ensuring only legitimate claims proceed.
Read more: How Sprout.ai reduces fraud and waste in insurance claims
Benefits:
– Prevention: Reduces the likelihood of fraudulent claims being approved.
– Efficiency: Frees up resources by quickly flagging suspicious claims for further investigation.
Continuous monitoring
Sprout.ai provides real-time updates and alerts about any new developments or information relevant to the claim, such as additional injuries reported by the police. It continuously monitors the status and progress of the claim, ensuring timely updates and actions.
Benefits:
– Proactivity: Allows insurers to stay proactive in managing claims.
– Customer satisfaction: Improves customer experience by providing timely updates and faster claim resolutions.
Data summarisation
Sprout.ai summarises all the documentation, including long-form police reports and expert assessments. This summarisation helps claims handlers quickly grasp the key facts, such as the number of vehicles involved and the primary causes, facilitating quicker decision-making.
Benefits:
– Clarity: Provides clear and concise summaries of complex data.
– Efficiency: Reduces the time needed to review extensive documents.
Policy checking
Sprout.ai cross-references the extracted claim data with the policyholder’s coverage terms. It checks policy limits and exclusions, ensuring that the claim is consistent with the policy’s stipulations. This automated check prevents delays in approval, as it quickly highlights any coverage issues or excesses that need attention.
Benefits:
– Accuracy: Ensures claims are thoroughly validated against policy terms.
– Speed: Accelerates the policy checking process, reducing delays in claim approval.
How Sprout.ai processes a flooded house insurance claim
Imagine a scenario where a severe flood damages a house, causing extensive structural damage, ruining personal belongings, and leading to potential health hazards from water contamination. Handling insurance claims for a flooded house can be highly complex and time-consuming when done manually. Claims handlers might struggle with the volume of data and detailed assessments required.
Sprout.ai overhauls this slow process by automating and streamlining many aspects of claims handling.
Data extraction and initial processing
Sprout.ai uses optical character recognition (OCR) and natural language processing (NLP) to quickly extract relevant information from various documents, including damage reports, photographs, repair estimates, and receipts. This technology can process unstructured data from handwritten notes, PDFs, and images.
Benefits:
– Speed: Significantly reduces the time spent on manual data retrieval, enabling faster initial processing.
– Accuracy: Ensures accurate and complete information capture, minimising human errors.
Damage assessment
Sprout.ai aggregates data from various sources including photos of the affected homes and expert repair estimates. By quickly analysing this information, it provided a comprehensive overview of the damage, correlating it with repair costs and timeframes.
This enables faster and more precise decisions on the necessary reparations.
Benefits:
– Efficiency: Speeds up the damage assessment process by quickly correlating information from multiple sources.
– Insight: Provides detailed insights into the damage, ensuring a comprehensive understanding of repair needs.
Validation and coverage
Sprout.ai compares the extracted data against the specific terms of the insurance policy to validate coverage. This includes checking policy limits, deductibles, and coverage for specific types of damage.
For example, it validates the claim by cross-referencing the claim data with the homeowner’s insurance policy. It checked the specifics such as policy limits, deductibles, and coverage for water-related damages, ensuring that the claim was processed in accordance with the policy terms.
Benefits:
– Accuracy: Ensures claims are validated against the policy terms accurately.
– Cost management: Helps prevent inflated claims and manages costs effectively.
Legal and regulatory compliance
Sprout.ai automatically checks claims against relevant legal and regulatory requirements to ensure compliance. It provides comprehensive documentation and analysis to support potential legal cases if disputes arise.
Benefits:
– Compliance: Ensures all claims processing activities adhere to legal and regulatory standards.
– Support: Enhances legal teams’ ability to handle litigation with robust data support.
Fraud detection
Sprout.ai detects inconsistencies and potential fraud in claims submissions by comparing data points against typical patterns. It can spot photos that have been doctored by checking the metadata, and it analyses current claims against historical data to identify unusual trends or outliers.
For exampl, it can discrepancies, such as inconsistencies in the reported timeline and doctored images, flagging the claim for further investigation and thereby preventing fraudulent payouts
Benefits:
– Prevention: Reduces the likelihood of fraudulent claims being approved.
– Efficiency: Frees up resources by quickly flagging suspicious claims for further investigation.
Continuous monitoring and updates
Sprout.ai provides updates and alerts about new developments or information relevant to the claim. It continuously monitors the status and progress of the claim, ensuring timely updates and actions.
For example, it alerts the insurer about additional damage discovered post-incident, ensuring that the claim was managed proactively and efficiently.
Benefits:
– Proactivity: Allows insurers to stay proactive in managing claims and addressing issues as they arise.
– Customer satisfaction: Improves customer experience by providing timely updates and faster claim resolutions.
Conclusion
Sprout.ai revolutionises the processing of complex insurance claims by automating data extraction, improving accuracy, facilitating better coordination, and enabling real-time monitoring. Whether you use it as an end-to-end solution, or just to speed up some aspects of claims handling, it leads to faster, more efficient claims processing, reduced fraud, and higher customer satisfaction. All of these help insurers handle even the most intricate claims with ease and precision.
