Claims Triage
This is the process of sorting high volumes of insurance claims by urgency. This is especially
important when there is a surge in claims submissions -- i.e., during a catastrophic event like a
hurricane or flood. AI and analytical tools can help insurers prioritize claims to save time,
money, and resources; thereby, increasing customer satisfaction while retaining business.
Here is how it would work:
1. The system would assign a complexity rating based on parameters from other
historical claims including severity, cycle time, physical damage, bodily injury,
and litigation/subrogation potential (among others).
2. The claims would be segmented and routed to the appropriate team and
adjuster based on their skill set and workload.
3. Low complexity claims would be routed to straight-thru-processing for
payment.
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In terms of fraud detection, speed of processing does come at a price. It is
estimated that fraudulent claims total at least $80 billion each year in the United
States. For property-casualty alone, that number hovers around $30 billion.
Insurers, on average, pay out up to 10% of their claims cost on fraudulent claims
annually. That is why more and more insurers are leveraging artificial intelligence
to detect fraud in insurance claims.
*It is important to note that the availability and accessibility to large amounts of
data (both internal and external) is critical here. The more data that's analyzed,
the better the system will be at identifying characteristics and patterns of fraud.
