AI Claims Handler

保险索赔处理依赖于对每一项索赔的人工审查，这对保险公司来说是很高的运营成本。因此，在索赔处理过程中存在着很大的摩擦，加快索赔支付是极其困难的。尽管行业协议（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The claim Portal上注册的索赔时，这个过程就会出现问题，保险公司必须在15天内评估索赔的所有细微差别，否则索赔将从系统中退出（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）。这一索赔过程在全行业的消费者中传达得很差。由此产生的高运营成本和诉讼需求的可能性推高了溢价。我们建立了一个独特的联盟，由法律专家（Kennedys）、领先的保险公司（AXA UK）和数据科学家（UMAN和Leap Beyond）组成，以创建一个解决方案，使索赔责任决策点自动化，并增强端到端的处理工作流程。我们的协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。使用开发的工具，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，并减少欺诈索赔的无意解决。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，以及加快索赔解决速度，提供更好的客户体验。

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.