Generative AI

The transformative impact of generative AI in revolutionising claims management

The modern insurance industry is on the precipice of a major shift, with rapid technological advancements catalysing the transformation of various insurance workflows at an unprecedented pace. AI in insurance is one such transformation propelling the insurance industry into the future, with generative AI being one of the highest-ranking trends insurers are the most interested in.

But what does AI in insurance claims look like? And how are generative AI systems improving insurance claim automation?`

AI in insurance claims

AI in insurance encompasses many workflows across customer service, claim assessment, risk assessment, policy drafting, insurance broking, and more. When it comes to leveraging AI for insurance claims processing, generative AI is playing a pivotal role in overcoming the challenges of traditional insurance claim processes. Be it time-consuming and tedious documentation, lack of personalisation, lack of real-time assistance, susceptibility to human errors, or overall slow processing, AI in insurance claims has been a game changer in overcoming these challenges and improving insurance claims processing efficiency.

Transforming insurance claims: Eight gen AI applications

AI and automation tools have played a significant role in improving insurance claims processing efficiency. However, generative AI systems shine in creating new content using deep learning techniques. As a result, insurers can not only gain data insights but also generate content for a personalised claims processing experience for customers.

Here are eight ways generative AI is transforming insurance claim automation and processing:

Distilling documents and flagging data points

Insurers have to spend hours poring over documents when processing insurance claims. Natural language processing (NLP) algorithms in generative AI tools can complete this task in minutes, extracting the necessary information from claim forms and other supporting documents, summarising them into claim notes, extracting specific information, or highlighting any points the insurance adjusters may have missed.

Automating insurance claims

Generative AI systems can enhance insurance claim automation by learning from past claims, identifying patterns, and automatically processing the claims that fall within specific parameters.

In the healthcare industry, this can reduce hospital administrators’ workloads, accelerate claim processing for more confidence in treatments, and improve the overall patient experience.

Detecting fraud

The insurance industry has been battling fraud since its inception, losing billions of dollars every year to fraudulent claims. Generative AI can help put an end to this by analysing claims data to identify suspicious patterns or anomalies indicating potential fraud. Once flagged, insurance investigators can work with relevant authorities and stakeholders to determine the best course of action.

Transforming customer service

Generative AI-powered chatbots can help overcome the challenges of lack of personalisation and real-time assistance in claim processing by quickly answering customer queries and supporting them through the claims process. This will not only improve customer satisfaction and loyalty but also ensure optimal utilisation of insurance adjusters' time.

Providing process overview and answers

Generative AI systems can also provide an overview of the claims process, including relevant stakeholders, their responsibilities, and benefits under their coverage, to the customers. Additionally, the NLP capabilities of generative AI mean the chatbots can understand and answer customer questions in a human-like manner to improve customer service and reduce the workload for claims administrators.

Lowering risk

In insurance claims processing, AI tools can analyse large amounts of claim data to identify patterns and help insurance administrators better understand various risks associated with different insurance policies. This can improve the accuracy of underwriting models and help develop more effective claim mitigation strategies. As a result, insurers can get more accurate policy pricing, lowering the risk of a loss.

Comparing claims

Generative AI can analyse past claims to identify patterns that can help estimate the outcomes of current claims. It can help identify similarities between past and current claims while accounting for various factors that can influence the claim.

Increasing employee satisfaction

Generative AI systems can help tackle the challenge of employee turnover by lowering the workload and increasing employee satisfaction. Insurance claim automation with generative AI can take care of repetitive tasks, allowing the employees to be more strategic, collaborate with different stakeholders, and bridge knowledge gaps within the team.

Each of these factors contributes to enhanced efficiency, accuracy, and customer experience while adding the "human touch" when leveraging AI in insurance claims.

How can Infosys BPM help?

Generative AI systems are playing a pivotal role in transforming insurance claims processing and insurance claim automation. With Infosys BPM’s AI-first platform, you can leverage the generative evolution to re-imagine your business operations and drive AI-first digital transformation as you accelerate submission summarisations, simplify policy compliance management, and automate claim communications.

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