Insurance Claims Processing Assistant

Timely and accurate claims processing is essential to maintaining customer satisfaction, but traditional claims management can be time-consuming, manual, and error-prone.

Our Claims Processing Assistant transforms the end-to-end claims process with frontier Generative AI to accelerate claims processing, improve accuracy, and enhance the customer experience. The assistant provides streamlined policy verification, claims routing, rate determination, and automatically generated insurance policies.

The solution uses advanced document extraction technology and fine-tuned extraction that models are pre-trained on a large corpus of insurance documents for high-accuracy data extraction. Advanced multimodal reasoning models process claims to accurately verify policy details like coverage limits, deductibles, and exclusions and understand images that are submitted as part of the claim. Intelligent claims routing routes claims to the most appropriate adjuster based on claim type, history, and complexity. 

Generative models are fine-tuned with historical claims data and optionally high-quality claims data from Scale Data Engine to then accurately determine pricing and policy details and generate insurance policies for final review by the adjuster.

• AI-Powered Summarization & Data Extraction
  Automatically summarize enterprise documents and extract critical data from text and images. This significantly reduces the time spent on manual document review and increases accuracy, enabling adjusters to effectively process more documents.

• Automated Policy Verification
  Instantly verify policy details like coverage limits, deductibles, and exclusions, reducing manual effort and speeding up claims processing.

• Smart Claim Routing
  Automatically route claims to the right department or adjuster based on claim type, history, and complexity for faster resolution.

• AI-Driven Rate Determination
  Leverage AI models to set accurate payout rates, reducing over/under-compensation and improving profitability.

• Policy & Documentation Generation
  Fine-tuned LLMs automatically generate all required documentation, accelerating the claims lifecycle and ensuring prompt payouts.

• End-to-End Automation
  Seamless integration automates claims processing from submission to documentation, reducing manual work and boosting efficiency.

This powerful Generative AI solution was built with:

• Advanced document extraction technology with multimodal frontier models that are pre-trained on a large corpus of insurance documents and images for high-accuracy data extraction.
• State-managed agentic workflows with decision trees for reasoning against complex constraints paired with claims routing data, ensure that claims are routed to the the most appropriate adjuster every time.
• Bespoke prompt engineering and turning, including in-context learning, few-shot learning, and task decomposition.