Automate Claims Processing with AiGs and Tungsten

Filing a claim is the most substantial interaction a customer can have with an insurance business. Aside from onboarding and policy payment, claims handling is the primary experience an individual will have with an insurer’s business processes and customer service. That makes the process very important to handle swiftly and accurately. However, manual processing with human agents is slow and poses numerous challenges. A means to automate insurance claims processing is essential today.

With the Tungsten Marketplace, businesses across different insurance categories can realize savings, operational improvements and better customer outcomes through automation. You can find pre-built solutions designed to add functionality or to act as fully developed tools to impact the claims processing workflow.

Why adopt one of these solutions? Consider some issues related to manual claims processing, then explore how two particular Marketplace solutions from one of our trusted partners, AiGS can provide a much-improved experience for all parties.

How Traditional Claims Processing Workflows Fall Short

While manual processing has been the norm across insurance agencies for many years, it’s commonly plagued by several problems. As an insurer grows and the scale of operations increases, those problems become more pronounced, making their impacts easier to see. Some of these problems include: 

• A lack of consistency in claims handling.
• Human errors introduced during manual data entry, leading to delays.
• Long processing times, slow turnarounds on claims, and poor customer experiences in a time of increased consumer expectations.
• Incomplete integration with additional systems causing data to experience delays before reaching downstream processes.
• High costs associated with inefficient processes.

So, how can companies automate the claims processing workflow, improve customer experiences, and enhance the bottom line? Marketplace solutions offer multiple options to help find the best solution. Let’s examine two solutions from AiGS, one of our Titanium-level partners, that can support different insurance companies.

CLAIMSAutomate for Medical Processing

Insurance spans several industry categories, from home and automotive to business insurance. CLAIMSAutomate by AiGS is a solution specific to the healthcare and personal injury insurance industries and the particular forms used in those industries. CLAIMSAutomate offers a robust and fully-featured workflow for capturing, classifying and validating medical insurance claims. Hundreds of pre-configured business rules simplify compliance to further reduce human intervention.

With CLAIMSAutomate, an insurer can better comply with HIPAA, exercise stronger controls against fraud and reduce paper touchpoints to eliminate opportunities for errors. Teams can better see claim status and manage exceptions when necessary. This solution is ideal for insurers in the medical industry operating at any scale and looking for a method to accelerate processes in a secure environment.

The solution is about more than extraction. Advanced validation enables the review of rejected claims that don’t meet business rules in a centralized portal. This keeps a human in the loop while claims that validate and meet the specified rules can move through the system. This triggers additional automated actions and ultimately leads to faster customer resolutions.

The AiGS AI Solution for TotalAgility

Another innovative way to support the automation of claims processing is available on the Marketplace from AiGS.

Make it simpler for agents to understand the answers to complex questions often found in dense data. For example, does a policy cover the particular circumstances of the claimed incident? Are there clauses that might affect the validity of the claim? Such questions can require extended periods of work time to derive useful answers. With the AI Solution for TotalAgility from AiGS, your organization can leverage AI beyond customer-facing chatbots to provide robust support in claims processing.

This solution allows users to access AI-generated document insights and capture detailed information from such documents. After document analysis, users can query different AI models (selectable based on use case or document type) to ask specific questions about the content. For example, an agent may query whether a policy contains relevant riders or whether the claim violates policy conditions. This resource then returns the AI-provided answer with in-document citations and a logic breakdown to combat hallucination and support confirmation of the answer.

From capturing document data to interacting with customers and finally accelerating work with the power of generative AI, there are many ways to impact the claims process with automation.

Accelerate Claims Processing in Your Organization Today

When ingesting and analyzing data related to claims occurs faster, your teams can improve case management and reach a resolution on a shorter timeline, which means faster service for customers. With an insurance payout on the line, a prompt resolution can make a real difference in the lives of customers and leave them with a positive impression of your brand, all because of better back-office processes.

We’ve explored several ways to automate insurance claims processing, from enhanced capture to innovative applications for artificial intelligence. With these Marketplace solutions from AiGS and the versatility of Tungsten platforms, insurance companies can rapidly deploy mature solutions that can have a clear and fast impact on workflows. Capture value early and enjoy a robust ROI on automation with the Tungsten Marketplace today.