AI Fatigue vs AI Enthusiasm: Real-World Impacts on Claims Processing

We’re all tired of the “experts” talking about artificial intelligence (AI) by now.

Yes, we get it: it’s changing the world, revolutionizing work as we know it. But there are genuine reasons for concern: sometimes AI hallucinates and states unreliable “facts.”

Most of us have read all the cautionary articles, but since AI is changing the world of work… we just want to see what it’ll mean for us, and how we can use it to (reliably and safely) improve our work processes and outputs.

All talk and no action is incredibly fatiguing, especially when the talk is all about “this is going to change everything,” yet we cease to see changes actually manifesting.

However, even in highly regulated industries like insurance, we are seeing the AI revolution take hold, and in some pretty impressive ways. Top insurance companies are already saving millions on their claims payouts and processing, thanks to AI’s ability to help them detect fraud and initiate better downstream processes after first notice of loss (FNOL).

Why AI in Insurance Requires Lots of Care

In some industries, workers can play around with AI without any severe consequences.

Creatives, for example, can experiment with AI to generate ideas and complete basic tasks, freeing them up to focus on the finer points of their projects.

In regulated industries like insurance, however, AI requires a more cautious approach. Using a tool that’s known to just make up false facts and state them as truth is risky when you’re combining with a highly regulated data set.

Regulated industries need to operate on stated, factual, provable data and nothing else. There’s no room for “fun” AI hallucinations, made-up facts, or incorrect conclusions.

That’s not to say that AI can’t be incredibly useful in insurance — because it can — but it needs to be used intelligently for well-defined means, not just as a generic tool to vaguely “help productivity.”

How EIS Uses AI to Assist Insurers & Save Them Millions

At EIS, we understand the critical need for precision and reliability in the insurance industry. That’s why we’ve developed ClaimSmart™, a machine learning and AI-powered solution designed to reduce fraud, streamline the claims process, and ensure accuracy and efficiency. ClaimSmart is made up of two main solutions: ClaimGuard™ and ClaimPulse™.

ClaimGuard: Proactive AI & ML-Enabled Fraud Detection

ClaimGuard acts as your vigilant, digital fraud guardian. Using AI and machine learning, it analyzes each claim throughout its lifecycle, proactively identifying potential red flags and irregularities for you. This minimizes false claims or overstated payouts, and maximizes your team’s resources. Here’s how it works:

  • Automatic Analysis: Each claim is analyzed throughout its lifecycle, surfacing potential fraud risks and irregularities.
  • Rapid Identification: Claims are identified and scored within minutes of the first notice of loss (FNOL), and risk scores are adjusted as more information is added to the claim.

ClaimGuard uses our proprietary risk-scoring insurance model, embedded with machine learning, to score claims based on hundreds of scenarios and data points. This continuous assessment updates fraud scoring and risk insights as the claim matures, seamlessly integrating with your existing core systems and third-party data sources.

ClaimPulse: Efficient, Personalized Claim Journeys that Result in Lower Loss Adjustment Expenses (LAE)

ClaimPulse creates a smoother and more personalized experience for both customers and internal claims teams. It automates workflows based on collected data, reducing processing time and lowering LAE. Key features include:

  • Customizable Experiences: Collect the right claim data upfront with responsive questions based on policy information.
  • Automated Workflows: Collected data feeds into and informs the entire claims journey via automated workflows, reducing processing time and lowering LAE.
  • Customer Empowerment: Allow customers to view their claim status and take action, enhancing transparency, trust, and satisfaction.

ClaimPulse maximizes every customer touchpoint, starting with digital FNOL. It customizes experiences to your line of business, personalizing workflows and triggering events across the customer journey.

See the Difference ClaimSmart Makes

Our customers are currently using ClaimGuard and ClaimPulse to improve scenarios across the entire claims process.

Tokio Marine and Nichido Fire save millions of dollars annually thanks to the fraud detection and claims automation ClaimSmart enables.

Another North American insurer slashed their LAE just by using ClaimPulse and improving FNOL.

See What ClaimSmart AI Can Do For You

Because ClaimSmart tools have been built to use data correctly and to act and update their models to get better over time, it’s one of the best ways for insurers to use AI in a way that’ll have a significant, substantial impact for them… giving ambitious insurers AI enthusiasm instead of AI fatigue.

See the ins and out of ClaimSmart, and what it can do for you right here.


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