If you’re ready to start automating claims processing, the first question you need to ask is: build or buy?

This decision will have a major impact on efficiency, cost, and overall business performance. 

Here, we’ll explore the factors to consider when deciding between an out-of-the-box solution like Sprout.ai and building your own claims automation system.

What are out-of-the-box claims solutions?

Out-of-the-box claims solutions are pre-built software applications designed to automate and streamline the claims processing workflow. These solutions are ready-made, allowing for quick deployment and easy integration into existing systems. They come equipped with standard features and functionalities tailored to common industry needs, enabling insurance companies to start using them with minimal configuration. 

Sprout.ai, for example, is a tested and proven claims processing tool that reduces operational costs and enhances efficiency.  It can also always be adapted to meet your specific needs.

What are bespoke claims automation solutions?

Bespoke claims automation solutions, on the other hand, are custom-built software applications tailored to meet the specific needs of an individual insurance company. These solutions are developed from scratch, often requiring extensive collaboration between the insurance company and software developers. 

While bespoke solutions offer the advantages of ownership and customisation, they also come with longer development times, higher costs, and greater risk due to the complexity and specificity of building such a tool.

Build or buy: What to consider

1. Time to deployment

When it comes to implementation speed, out-of-the-box solutions have a clear advantage. At Sprout.ai, we have a track record of quick and efficient deployments, with an average implementation time of just 16 weeks. This rapid deployment allows insurance companies to start reaping the benefits of automation without the lengthy development cycles associated with bespoke solutions.

Building a similar system from scratch could take years. You might use a model from OpenAI hosted on Azure to create your own secure GPT. However, you would still need to develop all the additional components we offer as part of our out-of-the-box solution. This includes an API spec that goes on top of any AI models, a data model for claims representation, and various specific elements like claim ID, policy ID, and insurance customer details.

Additionally, you would need to create agents within GPT to process documents, understand claim context, compare it against policies, and implement decision-based models to generate outcomes. While it is possible to do some of these tasks at the same time, Sprout.ai gives you a head start by combining all these elements in one ready-to-go package.

Read more: Did you know Sprout.ai can process claims documents in over 100 languages, from Japanese to Greek?

2. Cost 

Cost is another key consideration. 

An out-of-the-box solution is often ultimately cheaper than developing an in-house system. Creating a bespoke solution involves high initial costs and ongoing expenses for maintenance and updates, which can strain budgets and resources.

Sprout.ai’s out-of-the-box claims processing solution leads to a significant reduction in operational costs. For example, when a large health insurer was onboarded with Sprout.ai, 60% of their 1.5 million annual claims were fully automated within 16 weeks, from First Notice of Loss (FNOL) to claims decision.

Sprout.ai is also continuously updated with new features and capabilities, all included in the price.

Read more: How investing in automated claims processing reduces costs for insurers

3. Features and functionality

Developing a bespoke in-house solution involves creating and testing models from scratch. This process is time-consuming and prone to unforeseen challenges, as internal teams may lack this specific experience and real-world testing.

Sprout.ai’s pre-built models have been rigorously tested and proven in millions of real-world scenarios, significantly reducing the risk of unforeseen issues that can arise with bespoke development. By using advancements gained from working with diverse insurers from around the world, Sprout.ai continuously offers improvements and updates.

Sprout.ai offers advanced features like understanding file metadata to check for tampering that help process claims more quickly. These advantages are challenging for an internal team to achieve independently, regardless of their skill level. By choosing Sprout.ai, companies gain access to a broader spectrum of innovations and improvements that keep their claims processing efficient and up-to-date.

Sprout.ai also has automatic validation mechanisms that are not present in generic models like GPT. While GPT can provide answers, additional tools are needed to judge accuracy, compare against expected results, and integrate business logic. Sprout.ai offers a combined solution that integrates the model with business logic and claim context, streamlining the entire process.

Usability is a key factor in Sprout.ai’s efficacy. It has a user interface (UI) that allows for interaction when the automated solution doesn’t yield the expected results. This provides crucial insights and explainability, essential for effective claims management.

Read more: How does Sprout.ai use Large Language Models (LLMs)?

4. Knowledge and expertise

An in-house solution is limited by your company’s internal advancements and contacts. While internal teams may have a few people working on the challenge daily, they miss out on broader innovations happening globally.

The expertise of an experienced team can make a substantial difference. 

Sprout.ai has an industry-leading team of AI engineers and data scientists with extensive experience in delivering AI solutions to the insurance industry. This ensures it is robust, reliable, and capable of handling the complexities of insurance claims processing. Sprout.ai benefits from working with insurers across various regions, languages, and business lines. Innovations introduced by Sprout.ai for one customer, such as new methods for fraud detection or image processing, benefit all customers.

Read more: How Sprout.ai reduces fraud and waste in insurance claims

5. Core competencies

Out-of-the-box solutions allow companies to focus on their core competencies – serving their customers – rather than diverting resources towards developing and maintaining a claims processing platform. 

With Sprout.ai, there is no risk associated with solution development, conserving your resources, time, money, and talent.

6. Customisation

You might think that only by building your own solution can you customise it to your needs. That’s not always the case.

Sprout.ai is an out-of-the-box solution that can be tailored to fit specific needs. This means insurance companies can benefit from a proven, ready-made platform while also having the flexibility to customise features and functionalities that fit with their unique processes and requirements. 

This approach offers the best of both worlds: the rapid deployment and lower cost of an out-of-the-box solution combined with the adaptability of bespoke customisation.

7. Scalability

As your business grows, it’s essential to have a claims processing solution that grows with you. 

Sprout.ai is designed to handle increased volumes and complexities, ensuring that as your needs evolve, the system can adapt without significant overhauls. This future-proof approach ensures longevity and continuous alignment with industry advancements. 

In contrast, bespoke solutions might initially cater to specific needs but can require extensive redevelopment and additional investment to scale. Custom-built systems often face challenges in adapting to new technologies or increased demand, which can lead to significant delays and increased costs.

8. Maintenance

Maintaining and updating a claims processing system can be resource-intensive. 

Sprout.ai manages all maintenance and updates, ensuring your system is always up-to-date with the latest features and security enhancements. This removes the burden from your internal teams, allowing them to focus on core business activities rather than system upkeep. 

Bespoke solutions, in contrast, often require dedicated resources for ongoing maintenance and updates, adding to the long-term cost and complexity.

Comparing out-of-the-box vs. bespoke claims solutions

About Sprout.ai 

Customers describe Sprout.ai as the brains behind the scenes when it comes to claims processing. Our advanced technology significantly reduces the burden on claims handling teams by automating as much of the claims decision process as you like. This allows insurers to improve operational efficiency and support their customers more effectively.

It’s used by insurance leaders such as AXA, Metlife, and AdvanceCare, who wanted a solution that is ready to deploy, cost-effective, and backed by a team of experts.

Key benefits of Sprout.ai:

• 48% cost reduction in claims operations
• $21 cost reduction per claim, achieved 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

When deciding between an out-of-the-box claims solution and a bespoke claims automation system, you’ll need to consider various factors, including time to market, cost, functionality, expertise, and resource allocation. 

Building your own solution provides full control over the functionality and evolution of the system, but comes with higher costs, longer development times, and reduced access to data. On the other hand, Sprout.ai is customisable but also ready to deploy, cost-effective, and backed by a team of experts, allowing insurers to focus on their core business activities.