New Product Alert! ClaimSmart Launches a New Era of Data-Driven Claims Efficiency & Personalization with AI and ML

Earlier today, we made an exciting announcement about the set of solutions we offer insurers looking to stop claims leakage and provide a personalized, real-time claims experience for all parties involved.

ClaimSmart™, reflective of our relentless pursuit of innovation at EIS®, is cutting-edge in the realm of data science in insurance, and is a pivotal step towards redefining insurance claims management with future-proof technology. With AI and machine learning (ML) at its core, ClaimSmart is designed to complement and enhance existing claims management solutions, like our own ClaimCore®, or any other claims management system an insurer uses. 

While ClaimSmart can still fully and seamlessly integrate with any core system an insurer uses, integrating ClaimSmart with ClaimCore from EIS gives insurers some especially great advantages in the marketplace. (Which we’ll get into below!)

But first, what exactly is ClaimSmart?

ClaimSmart is an AI-and machine-learning-powered cloud solution that eliminates redundant manual work in claims processing, boosts fraud detection, and provides a much better customer experience. The two parts of ClaimSmart, ClaimGuard™ and ClaimPulse™, have their particular areas of specialty: 

ClaimGuard is our AI and ML solution that detects fraud and scores each claim for fraud risk, enhancing the security and integrity of the claims process. With advanced analytics and a cutting-edge machine learning algorithm, ClaimGuard automatically analyzes the data points of each claim with a nuanced risk scoring system. This ensures legitimate claims get processed and closed quickly, while claims requiring more scrutiny are passed to the appropriate claims examiners for review and outcome determination. 

As you use ClaimGuard and give it more feedback on which claims were and were not fraudulent, it picks up on nuances humans might miss, helping you spot claims and stay ahead of new schemes insurance fraudsters cook up. 

ClaimPulse integrates with your existing claims processing system (whether it’s EIS ClaimCore® or another solution), and adds in a smart layer of efficiency and technological sophistication. 

Using digital FNOL as an initial touchpoint with a claim, ClaimPulse uses reflexive questioning based on ingested claim data and a claimant’s policy coverage. Manual processing, data entry errors, and the need for claimant follow-ups to gather more information are reduced. Plus, collecting all the correct data automatically and upfront means more downstream automations and efficiencies are possible, speeding up the time from initial FNOL to resolution.

Why ClaimSmart + EIS?

When you pair ClaimSmart with ClaimCore from EIS Suite, things get really exciting and even more streamlined for a better customer (and insurer) experience. 

Because the architecture of EIS Suite is fully customer-centric and event-driven, you’re able to integrate ClaimSmart to do things other insurers can’t, like: 

  • Automatically setting off a chain of events that can be processed 24/7 the instant a new piece of required data is entered on a claim, potentially taking it as far as closure. 
  • Automate and customize customer communications about each step of the claims process, giving a hand-holding experience like no other‌ — ‌without your customer service reps lifting a finger. 
  • Automate customer-specific workflows to handle those who submit fraudulent claims. 
  • Give the highest level of transparency into claims processing, so customers, brokers, and everyone involved knows what’s happening, and they get more information when they check on the claim than simply “processing.” 
  • If a piece of data is picked up that a claim needs to be started, the system can create a digital FNOL for the insured, and workflows can immediately step in to get the customer or other parties involved to input needed information.

Curious How Much ClaimSmart AI Could Save You?

If reducing claims leakage and optimizing your claims processing is something you’d like to start taking care of in the next year or so, get in touch with a member of our team. Even if you’re not using EIS Suite right now, ClaimSmart can do a lot for you, and we’d love to help you figure out how it can better impact your KPIs, and how that translates to money saved.


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