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AdvanceCare unlocks end-to-end claims automation and real time processing with Sprout.ai

AdvanceCare can scale by serving more customers, while maintaining an exceptional claims experience

Invoices from many categories, including hospital, dental, pharmaceutical, independent workers and optical were processed with a high degree of accuracy

Sprout.ai’s AI technology increases the work capacity and reduce the work volume per team member

AdvanceCare is now using Sprout.ai’s technology to automatically extract relevant data from healthcare invoices. This follows a successful pilot, in which AdvanceCare cut down the claims settlement turnaround time to near real time.

Healthcare insurance group AdvanceCare integrated with the Generali Group, an international group present in more than 50 countries, in 2020. The merger enhanced their ability to grow and serve more customers.

With Sprout.ai’s technology, AdvanceCare will unlock full end-to-end claims automation, allowing the team to index claims with far greater efficiency and speed. 

The pilot

During the pilot, Sprout.ai analysed a significant sample of healthcare invoices across a series of categories of invoices, including hospital, dental, pharmaceutical, independent workers and optical. The pilot outcomes showed very high accuracy levels in the collected fields across all categories.

Sprout.ai’s AI technology will increase the work capacity and reduce the work volume per team member. AdvanceCare will be able to scale up its business by serving more customers, while maintaining an exceptional claims experience. 

With Sprout.ai, claims handlers no longer need to spend their time on low-value, repetitive tasks, allowing them to dedicate more quality time to tasks that are more valuable and rewarding, optimising the customer experience.

Sprout.ai supports digitalisation and efficiency 

“AdvanceCare is continuously looking for innovative ways to improve the insurance claims experience,” said Sergio Melro, chief operating officer at AdvanceCare.

“We selected Sprout.ai as our partner as they have demonstrated that their technology and approach can take us one step forward in our digitalization and efficiency journey.”

In the past year, Sprout.ai has partnered with several new customers in the Health and Property & Casualty (P&C) categories including an international health insurance provider in APAC, and other leading insurers Zurich and Metlife.

Sprout.ai CEO Roi Amir said: “We are delighted to be partnering with AdvanceCare, one of the largest health insurance platforms in Portugal.”

“Using AI in the indexing process will allow the AdvanceCare team to manage claims quicker and more efficiently, improving the customer experience. It’s a win-win for everyone and we are happy to be part of this positive change.”

About Sprout.ai

Sprout.ai is an end-to-end claims automation technology solution for the insurance industry. Sprout.ai works in partnership with major insurers, including Zurich UK, Metlife and AdvanceCare to build groundbreaking AI and data-led products to automate the claims process for customers. 

Sprout.ai’s vision is to provide a frictionless claims experience to everyone in the world. The average time it takes for insurers to process claims is around 30 days. At a time when you’re emotionally and financially vulnerable, this is often frustrating and stressful. Sprout.ai enables insurers to make a decision on a customers’ claim, in near real-time. Sprout’s technology delivers fast and accurate decisions and an exceptional claims experience, driving high customer retention with improved efficiency. 

To learn more about how Sprout.ai can boost efficiency and enhance customer experience, book a call with one of the team.

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Major South American insurer unlocks end-to-end claims automation with Sprout.ai

  • One of the biggest insurance providers in South America is using Sprout.ai to drastically cut claims processing time
  • 50% to 60% of the insurer’s million annual claims will be automated
  • The insurer selected Sprout.ai to help it reduce claim resolution time, reduce rejection time, improve customer experience, increase tNPS scores and continue to drive innovation 

One of the biggest insurance providers in South America, is now using our claims automation technology to process claims and improve customer satisfaction. Their entire claim process, from data extraction, to decision-making and action, will be enhanced and sped up by our AI and data-led products.

Over 50% of the insurer’s million annual claims will be automated, enabling the claims handling team to spend more time working directly with customers. 

It previously took weeks for the insurers’ policyholders to learn about the outcome of their claim. Now, claims can be resolved in real time.

The insurer, one of the world’s largest, tested our technology in a POV. In that time, 30% of claims were fully processed using our technology. 

Sprout.ai is helping the insurer to:

  1. Reduce claim resolution time
  2. Reduce rejection time by identifying fraudulent claims and policy mistakes faster
  3. Improve customer experience with quick claims processing and reduced human error
  4. Increase tNPS scores as customers experience a smoother claims process
  5. Continue to drive innovation and transformation internally and across the insurance industry

At the end of the POV, the insurer decided to bring us on as a partner in their claims process.

“This partnership with Sprout.ai will be very beneficial for us and our customers alike. The pilot demonstrated that Sprout.ai’s market-leading innovative technology can deliver true end-to-end claims automation with no need for human involvement. This type of technology is exactly the kind of innovative solution that we are looking to implement to make us more efficient and improve customer experience and satisfaction.

Why our claims automation offering is unique

Our groundbreaking AI and data-led products are automating claims processes for leading insurers around the world. Our technology can read the contents of individual insurance policies to analyse coverage and conditions, and then match and settle the claim. This creates a frictionless claims experience and will drive high customer retention with improved efficiency. 

Other providers offer either claims automation or fraud filtering, but our light touch solution delivers both. Engineering this state-of-the-art tool has been made possible by fusing the power of machines and a vast external data network. The result is a non-intrusive solution that enhances data, offers actionable insights on fraud suspicions and automates claim processes.

About Sprout.ai

We are an end-to-end claims automation technology solution for the insurance industry. We work in partnership with major insurers, including Zurich UK and AdvanceCare, part of the Generali Group, to build groundbreaking AI and data-led products to automate the claims process for customers. 

Our vision is to provide a frictionless claims experience to everyone in the world. The average time it takes for insurers to process claims is around 30 days. At a time when you’re emotionally and financially vulnerable, this is often frustrating and stressful. We enable insurers to make a decision on a customers’ claim, in near real-time. Our technology delivers fast and accurate decisions and an exceptional claims experience, driving high customer retention with improved efficiency. 

We have raised $15 million to date from top tier investors Octopus Ventures, Amadeus Capital Partners and Playfair Capital.

Key features

Data extraction and enrichment

Our technology generates contextual reasoning through using NLP and Knowledge Graphs. NLP is used to understand the contents of the policy document and enables us to build the rules within the policy to automatically check whether the claim is valid in regard to the policy agreement.

Policy Check

Once NLP has interpreted the policy document, we match this to the description of the claim to automatically check whether the claim is covered under the customer’s specific policy.

Interested in learning more about automating your claims processes?
Speak to the team

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Sprout.ai tech means Zurich can now resolve property claims within 24 hours

zurich property insurance logo

The insurance media is buzzing this month with the news that a trial of the Automated Policy Checking AI solution developed by Sprout.ai means Zurich Insurance can cut property claims settlement times to sub 24 hours. The announcement was made following a three-month pilot of the technology, run between December 2020 and February 2021.

What is Automated Policy Checking?

This AI engine uses what we call explainable AI – tools like Natural Language Processing and Knowledge Graphs add layers of context and aid decision making. To put the software’s capabilities into context, its speed and ability are the equivalent of a claims handler with 100 years’ experience and a reading speed of 10,000 words per microsecond. That equates to 600 million words per minute, compared to the most commonly cited average human reading speed of 300 words per minute.

The software is not, however, designed to replace claims handlers any more than a calculator is designed to replace an accountant. On the contrary, it is a tool that the handler uses and drives in order to aid decision-making and to triage and process claims better and faster. That was the exact outcome of the three-month pilot at Zurich.

Better accuracy, improved transparency

Checks found an accuracy rate of more than 98 percent during the pilot, which exceeds the average accuracy of human claims handlers. By automatically providing links to the insurance ombudsman data used to arrive at each recommendation, it also means there is greater transparency to support every decision.

The AI solution was developed using more than 20,000 historic claims. However, it is important to understand that those were just the beginning – they can be thought of as the training material used so that the software could learn its craft. Every new claim added to the database brings new knowledge and experience, and as with a human claims handler, this will help the AI to keep getting better at what it does.

A success for all

The pilot is part of a company-wide commitment to innovation at Zurich aimed at delivering a faster service with the best possible outcomes for every customer. Everyone involved in the pilot, from the claims handlers to the executive decision makers, felt that it was an unqualified success in helping the company achieve those goals.

One highly experienced claims handler who was directly involved in the pilot took the trouble to email us at Sprout.ai afterwards. Here’s what she said:

Just want to say thanks for the opportunity to participate in the pilot, it’s been great fun and I’ve certainly learned some things along the way! The Sprout.ai team have been second to none and fully invested/listened in our feedback to ensure it’s a success for all! I will certainly be singing your praises.”

Meanwhile, Amy Brettell, Zurich’s Head of Customer, UK Claims described this project as “a fantastic example of a collaboration which provides a true solution to some of the issues that often stand in the way of creating customer loyalty and helping rebuild trust in our sector.”

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Blockclaim launches healthcare pilot with major European partner

Think of contextual AI in the insurance sector, and your mind has a tendency to go straight to the automotive and perhaps home insurance markets. These, after all, are the types of insurance most commonly associated with fraudulent claims. However, insurance fraud goes way beyond these specific silos and Blockclaim’s software solutions similarly go beyond fraud detection and prevention.

This is plainly demonstrated in the latest pilot project, in which Blockclaim is working alongside one of Europe’s giants in risk consultancy and medical insurance to implement contextual AI solutions. For this particular case, the technology will be used to automatically match treatment and medication with patient conditions and illnesses.

More data means better results

Contextual AI seeks to enrich insurance claims data by using relevant contextual data to increase the information that Machine Learning algorithms use in order to learn. It is literally a training process, and the more they study, the better and more accurate they become at what they do.

It creates a virtuous circle, a little like a human in some specialist sphere, who inevitably gets better at what he or she does with practice and experience. The ultimate outcome is more accurate predictive performance compared with the conventional AI solutions currently in place.

To get the training process underway, the client has provided Blockclaim with more than 10,000 historical data entries, each of which has information on medical conditions and the medications prescribed. We have then been able to add further enrichment and detail to this data.

Challenges

It goes without saying that automating any part of a medical diagnosis process needs to be approached extremely cautiously and methodically. As things stand at present, there is a standard requirement for the manual approval of any medical condition to illness correlation and that this step must take place three times for each patient before the process can be automated. Yes, that’s three times for every patient.

Extra use possibilities

During a workshop session, it soon became clear that use of Blockclaim’s technology could easily be expanded to bring additional side benefits. These include recognising different variants of similar medications, automation of new medication entries and analysis of both medical conditions and their treatments to bring yet richer data.

Potential savings

With the present level of AI usage, the client is able to automate around 564,000 claims per year. This corresponds to a financial saving of around €285,000. Just by enhancing these processes to contextual AI, the savings could be increased by around 38% to €388,000. However, that is only the beginning.

Further development of contextual AI into a second stage would see the savings increase to more than €1 million. Even this, however, does not take into consideration the extra use possibilities. When they are factored in, the anticipated savings mount to more than €2.3 million per year.

A world of possibilities

Faster and more accurate diagnoses that at the same time result in such significant cost savings represent a win / win for both the industry and the patients it serves. The findings so far represent only the tip of the iceberg in what can be achieved. There are exciting times ahead, and Blockclaim is proud to be at the heart of this innovative development.

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media@blockclaim.ai

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