AI Claims Handler

人工智能理赔处理程序

• 批准号: 35115
• 金额: $ 138.32万
• 依托单位: KENNEDYS LAW LLP
• 依托单位国家: 英国
• 项目类别: Collaborative R&D
• 财政年份: 2019
• 资助国家: 英国
• 起止时间: 2019 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=35115
• 关键词: AI; Claims; Handler

Insurance claim-processing is reliant on the manual review of each and every claim, at high operational costs to insurers. As a result significant friction exists in the claims processing pathway, and it is extremely difficult to expedite claims payment. Although industry protocols (including The Claims Portal) aim to reduce this friction, insurance claims will often also need adjustment to reach a settlement and determining liability can often result in the need for litigation. This process comes to a head when considering claims registered on The Claims Portal where the insurer must assess all the nuances of a claim within 15 days else the claim falls out of the system (at high cost to the insurer, and often results in substantial (300+days) processing delays). This claims process is poorly communicated to consumers industry-wide. Resultant high operating costs and likelihood of the need for litigation drive up premium prices.We have built a unique consortium comprised legal experts (Kennedys), leading insurers (AXA UK) and data scientists (UMAN and Leap Beyond) to create a solution to automate the claims liability decision point and augment the processing workflow end-to-end. Our collaborative approach capitalises on our commercial assets to address the primary developmental barriers which have hindered the development of automation to date.With the developed tool we will reduce the overhead cost of claims processing, reduce the litigation spend for claims settlement, and reduce inadvertent settlement of fraudulent claims. Ultimately, this will lower the cost of insurance premiums for the consumer.This project will additionally enable better customer experience through increased transparency and explainability of the claim process, and expedited claim settlement.

保险索赔的处理依赖于对每一项索赔的人工审查，给保险公司带来很高的业务成本。因此，在处理索赔的过程中存在重大摩擦，而且极难加快支付索赔。虽然行业协议（包括索赔门户）旨在减少这种摩擦，但保险索赔通常也需要调整以达成和解，并且确定责任通常会导致需要诉讼。当考虑在索赔门户网站上登记的索赔时，这个过程达到了顶点，保险公司必须在15天内评估索赔的所有细微差别，否则索赔福尔斯将从系统中删除（对保险公司来说成本很高，并且通常会导致大量（300多天）的处理延迟）。这种索赔过程在整个行业内与消费者的沟通很差。由此产生的高运营成本和诉讼需求的可能性推高了保费价格。我们建立了一个由法律的专家（AXA UK）、领先的保险公司（AXA UK）和数据科学家（UMAN和Leap Beyond）组成的独特联盟，以创建一个解决方案，实现索赔责任决策点的自动化，并增强端到端的处理工作流程。我们的合作方法利用我们的商业资产来解决迄今为止阻碍自动化发展的主要发展障碍。借助开发的工具，我们将减少索赔处理的间接成本，减少索赔解决的诉讼支出，并减少欺诈性索赔的意外解决。最终，这将降低消费者的保险费成本。该项目还将通过提高索赔流程的透明度和可解释性以及加快索赔解决来改善客户体验。