Re-Designing Claims Process for Customers with the Help of AI Integration and Technology
The COVID-19 pandemic has clearly forced organizations to think of innovative solutions for catering to its consumers. For an industry like insurance which happened to be physical intensive, it has brought about increased adoption of digital methods of fulfilment in the insurance life cycle. Digital means of servicing has become extremely important during this time and as an organization, our early investments in technology have helped us in helping customers use digital means for intimating claims in all our products. Our investments in solutions that help in conducting virtual surveys in motor and commercial lines of business have helped us tremendously during the pandemic period.
Our journey of making motor claims processing easier started in the year 2017 when we introduced Instaspect, our motor inspection app that helps in virtual survey of motor own damage claims. This has helped us in processing claims at remote locations without physically sending the surveyor to the location. With InstaSpect, a garage operator can conduct a video survey of a vehicle using our mobile app and an ICICI Lombard surveyor can instantly process the claim basis the video survey. This helps expedite the claims process journey for customers. We saw an increased number of customers and garages availing of this service during the pandemic.
At ICICI Lombard, we leverage new-age technologies such as artificial intelligence (AI) and machine learning (ML) to help make customer journeys easier. One of our first AI solutions was the motor break-in AI solution. This solution helps customers whose policies have lapsed to simply click and upload photographs of their car using our app. An AI solution on the cloud helps analyze these images to identify damages to the vehicle and automatically decides on whether the policy needs to be issued or needs to be looked at by a manual inspector. Prior to this solution being implemented, it used to take almost 24-72 hours post a customer had indicated his inclination to renew their policy that had lapsed. This time was based on the volume of such inspections and the availability of the customer. Currently, this process is now done within minutes and ~ 75% of our break-in inspections gets processed straight-through first time using this solution. During the pandemic, we were able to accommodate 3 times the volumes of such inspections since these models have been deployed on the cloud using extensible architecture. Since these models identify damages to motor vehicles and parts, they are also being used currently at the time of motor claims to identify damages and for predicting claims costs.
Similarly, on the health side, for our group health customers, our AI/ML solution has helped reduce the claims cashless authorization time from 90 minutes on average to 90 seconds. Previously a doctor used to be looking at the pre-authorization form submitted by the hospital which now gets fed to the AI/ML engine. The reduction in time reduces the anxiety for the customer and helps them to take care of their loved ones during hospitalization as compared to waiting for their insurance organization to approve the same. Today, > 60% of our corporate health cashless claims are authorized using this solution. This number has doubled as compared to the number a year ago. Since the AI/ML solution is now authorizing these straight-forward claims, qualified doctors are now able to spend more time on complex claims.
Benefits of AI Integration and Technology
We have seen multiple examples where technology is playing a significant role in simplifying the claims process for customers. Surveys are an important part of the claims journey and virtual surveys are helping increase efficiency in the claims survey process. New-age technologies such as AI and ML are taking images from these surveys to predict damages on vehicles to help make the motor break-in and claims process more efficient. Leveraging AI and ML during the cashless pre-authorization for health claims is reducing the time taken for authorization to 90 seconds.
Similarly, our virtual remote inspection of commercial property is helping us assess commercial risk remotely. Multiple engineers can now assess the risk from a central location and guide customers on how to mitigate risks and have better risk management practices. Our tele-consult feature Hello Doctor on the ILTakeCare app helps customers to have video consultations with doctors. As we speak, more and more solutions continue to be created around video and voice that help us in providing seamless digital servicing to our customers.
However, to ensure that we can offer such seamless service to our customers, we needed solutions that helped us in identifying customers that can potentially take undue advantage of the system. So, each one of our digital claims solutions is backed up by powerful fraud identification solutions that help us in identifying new patterns of fraud that keep emerging. Earlier, we would flag off claims that needed scrutiny basis rules and triggers that were put in the system. This would be investigated thoroughly and marked as fraudulent or kosher basis the investigation. Today, with significant data availability and technology, we have started using AI and ML based fraud detection models to predict and highlight probable fraudulent claims in real-time. All this happens immediately, once the claim is intimated and logged within the system. The continuous self-learning approach of these ML algorithms helps us to implement solutions that autocorrect very quickly reducing the time for learning and execution. These algorithms are helping us in identifying and prevent frauds faster and giving us higher efficiency to the extent of 30% in some cases.
Additionally, just augmenting existing the risk function with AI and ML solutions basis data captured is not enough. New-age big-data platforms are helping us in creating a sophisticated single view of the customer using a combination of internal and external data. This helps in assimilating data related to a customer in one single view, helping create richer fraud identification models at a customer level. However, just building these at a customer-centric level is not enough. Prior investigation experience suggests that many times there exists a network of people behind any fraudulent activity. Hence, it is important to build fraud network models that help in identifying the nexus of partners that are involved. Every organization should strive to have a combination of these models that help in identifying higher number of fraudulent cases and eventually reduce the outgo from such claims. This obviously will help in reducing overall claims cost at an industry level which can then be passed onto the consumer in the form of lower premiums.
We are seeing significant results in areas where we have been leveraging some of the technological solutions outlined above. Our break-in AI solution is helping process ~ 75% of break-ins straight through using images taken by the customer as a part of the break-in survey. Our reliant on elastic cloud infrastructure has helped us absorb 3 times the volume during the pandemic without any loss of productivity or efficiency. Our health cashless authorization solution for corporate customers reduces the time to approve an authorization request to 90 seconds. > 60% of all such claims were processed using the AI/ML solution, this number being double of the authorized number a year ago. Our big data and ML driven fraud solution is helping us in increase our efficiency by 30% in specific areas of fraud identification and prevention.
We continue to try and make life easier for our customers through these new-age solutions. Our natural language processing enabled BOT helps make it easier for customers to intimate a claim, find a garage or hospital to ensure that they can find this information easily. Digitization of documents using ICR/OCR technology in our claims processes is helping us in automating our processes and making the end-to-end claims process quicker and easier for our customers. Our seamless API-driven integration with new-age digital partners and channel partners is helping us provide this seamless service to consumers. We continue to experiment with newer technologies such as IoT and drones to help in claim intimation as well as claim surveys. Such technologies are also helping in risk management as compared to claims management.
Role of Chief - Customer Service, Technology and Operations in Claims Process
As we see businesses evolve due to new advances in technology, the role of senior management in strategic planning has gained utmost importance. Chief technology officer’s (CTO) roles are as much today about technology innovation as much as managing information technology. To respond to the demands of digital business, CTOs are being looked at as visionaries of identifying and adopting new technologies that will help transform traditional business models. CTOs today are spending more time on technology innovation programs at the same time juggling their time on operational needs. Most of the CTOs in insurance organizations today are identifying business problems that can be solved in the fields of Machine Learning (ML) and Artificial Intelligence (AI), Internet of Things (IoT), Telematics / Telemetry, Big Data and Data Analytics, just to name a few. Senior leaders in organizations are more and more becoming key enablers for transforming companies towards a more customer-focused, tech-centric, collaborative problem-solving and agile organization.
One of the core pillars that we at ICICI Lombard believe in is a sharp focus on technology-led innovation. We think of ourselves as a tech company that also does insurance, and our mindset is geared along those lines. Obviously, our journey on those lines continues and technology continues to be our focus area. A lot of the solutions that have been built are not just built by technology or data science teams but by business teams such as underwriting, claims, customer service together with the data science & technology teams. As an organization, we are developing multiple such solutions using this model of co-creation. There has been a significant change in the mindset of the organization and teams are working together in an environment using agile methodologies that helps in developing such solutions in quick time.
Whenever a new idea is generated, a small agile team looks at the core problem that they are trying to solve for their channel or for their customer. Then they come and work with multiple stakeholders and come up with a small solution. For example, the break-in AI solution is a function of a lot of the data that we collected from our Instaspect app. The original idea of the remote inspection using Instaspect was to improve productivity and to increase convenience for our customers and the garages to settle claims where we could not send people speedily for remote services. But from there, the business team came out with an idea that why do not we use some of these processes to underwrite policies when there has been a break-in in terms of the policy period. Traditionally, we would send a surveyor to look at what has happened and then take images and then go ahead and provide a cover if there were no damages in the interim period. The team thought that we could use the same tool, and since we were capturing images for more than 10 years, we could use those images to build an AI/ML solution which could disrupt the current process. This led to the motor break-in AI solution as it stands today.
Newer technologies on the digital front, including Artificial Intelligence and Machine Learning will play a major role in providing innovative solutions from a customer experience standpoint. As consumer expectations and behaviors change, we believe that the insurance industry will continue to change by embracing newer technology, be it through an AI chatbot that acts as a Virtual Insurance Advisor, or an AI detection model that acts as a Digital Claims Adjuster or a ML model that acts a smart underwriter. There will be prolific use of AI, ML and cognitive services that will help address needs such as digital adoption, customer experience management, operational efficiency, underwriting profitability, claims optimization and much more. Specifically, on the claims side, IoT, drones, telematics and wearables will play a higher role in prevention of incidents as compared to traditional claims management. Automated customer service handled through voice and text will continue to aid customers during the claims process and sophisticated natural language processing and natural language understanding algorithms with help identify fraudulent customers.
Consumer and stakeholder behavior changes will continue to drive the operating model of any business. While we have been developing digital means of servicing and distribution since quite some time, the pandemic accelerated the adoption of various tools for consumers as well as stakeholders. Similarly, we expect that remote working including part-time working will help us in increased productivity due to reduced travel time especially in large cities like Mumbai, Delhi and Bangalore. We will continue to invest in new-age technologies, including cloud, AI/ML and IoT, that continue to help develop solutions that cater to the needs of our customers. The ability of organizations to adapt to change amidst changing consumer behavior and expectations, to roll out products and innovations quickly and bring them to market, and to form sustaining and lifelong partnerships will define how companies will be successful in the long term.
Our journey of making motor claims processing easier started in the year 2017 when we introduced Instaspect, our motor inspection app that helps in virtual survey of motor own damage claims. This has helped us in processing claims at remote locations without physically sending the surveyor to the location. With InstaSpect, a garage operator can conduct a video survey of a vehicle using our mobile app and an ICICI Lombard surveyor can instantly process the claim basis the video survey. This helps expedite the claims process journey for customers. We saw an increased number of customers and garages availing of this service during the pandemic.
At ICICI Lombard, we leverage new-age technologies such as artificial intelligence (AI) and machine learning (ML) to help make customer journeys easier. One of our first AI solutions was the motor break-in AI solution. This solution helps customers whose policies have lapsed to simply click and upload photographs of their car using our app. An AI solution on the cloud helps analyze these images to identify damages to the vehicle and automatically decides on whether the policy needs to be issued or needs to be looked at by a manual inspector. Prior to this solution being implemented, it used to take almost 24-72 hours post a customer had indicated his inclination to renew their policy that had lapsed. This time was based on the volume of such inspections and the availability of the customer. Currently, this process is now done within minutes and ~ 75% of our break-in inspections gets processed straight-through first time using this solution. During the pandemic, we were able to accommodate 3 times the volumes of such inspections since these models have been deployed on the cloud using extensible architecture. Since these models identify damages to motor vehicles and parts, they are also being used currently at the time of motor claims to identify damages and for predicting claims costs.
Similarly, on the health side, for our group health customers, our AI/ML solution has helped reduce the claims cashless authorization time from 90 minutes on average to 90 seconds. Previously a doctor used to be looking at the pre-authorization form submitted by the hospital which now gets fed to the AI/ML engine. The reduction in time reduces the anxiety for the customer and helps them to take care of their loved ones during hospitalization as compared to waiting for their insurance organization to approve the same. Today, > 60% of our corporate health cashless claims are authorized using this solution. This number has doubled as compared to the number a year ago. Since the AI/ML solution is now authorizing these straight-forward claims, qualified doctors are now able to spend more time on complex claims.
Benefits of AI Integration and Technology
We have seen multiple examples where technology is playing a significant role in simplifying the claims process for customers. Surveys are an important part of the claims journey and virtual surveys are helping increase efficiency in the claims survey process. New-age technologies such as AI and ML are taking images from these surveys to predict damages on vehicles to help make the motor break-in and claims process more efficient. Leveraging AI and ML during the cashless pre-authorization for health claims is reducing the time taken for authorization to 90 seconds.
Similarly, our virtual remote inspection of commercial property is helping us assess commercial risk remotely. Multiple engineers can now assess the risk from a central location and guide customers on how to mitigate risks and have better risk management practices. Our tele-consult feature Hello Doctor on the ILTakeCare app helps customers to have video consultations with doctors. As we speak, more and more solutions continue to be created around video and voice that help us in providing seamless digital servicing to our customers.
However, to ensure that we can offer such seamless service to our customers, we needed solutions that helped us in identifying customers that can potentially take undue advantage of the system. So, each one of our digital claims solutions is backed up by powerful fraud identification solutions that help us in identifying new patterns of fraud that keep emerging. Earlier, we would flag off claims that needed scrutiny basis rules and triggers that were put in the system. This would be investigated thoroughly and marked as fraudulent or kosher basis the investigation. Today, with significant data availability and technology, we have started using AI and ML based fraud detection models to predict and highlight probable fraudulent claims in real-time. All this happens immediately, once the claim is intimated and logged within the system. The continuous self-learning approach of these ML algorithms helps us to implement solutions that autocorrect very quickly reducing the time for learning and execution. These algorithms are helping us in identifying and prevent frauds faster and giving us higher efficiency to the extent of 30% in some cases.
Additionally, just augmenting existing the risk function with AI and ML solutions basis data captured is not enough. New-age big-data platforms are helping us in creating a sophisticated single view of the customer using a combination of internal and external data. This helps in assimilating data related to a customer in one single view, helping create richer fraud identification models at a customer level. However, just building these at a customer-centric level is not enough. Prior investigation experience suggests that many times there exists a network of people behind any fraudulent activity. Hence, it is important to build fraud network models that help in identifying the nexus of partners that are involved. Every organization should strive to have a combination of these models that help in identifying higher number of fraudulent cases and eventually reduce the outgo from such claims. This obviously will help in reducing overall claims cost at an industry level which can then be passed onto the consumer in the form of lower premiums.
We are seeing significant results in areas where we have been leveraging some of the technological solutions outlined above. Our break-in AI solution is helping process ~ 75% of break-ins straight through using images taken by the customer as a part of the break-in survey. Our reliant on elastic cloud infrastructure has helped us absorb 3 times the volume during the pandemic without any loss of productivity or efficiency. Our health cashless authorization solution for corporate customers reduces the time to approve an authorization request to 90 seconds. > 60% of all such claims were processed using the AI/ML solution, this number being double of the authorized number a year ago. Our big data and ML driven fraud solution is helping us in increase our efficiency by 30% in specific areas of fraud identification and prevention.
We continue to try and make life easier for our customers through these new-age solutions. Our natural language processing enabled BOT helps make it easier for customers to intimate a claim, find a garage or hospital to ensure that they can find this information easily. Digitization of documents using ICR/OCR technology in our claims processes is helping us in automating our processes and making the end-to-end claims process quicker and easier for our customers. Our seamless API-driven integration with new-age digital partners and channel partners is helping us provide this seamless service to consumers. We continue to experiment with newer technologies such as IoT and drones to help in claim intimation as well as claim surveys. Such technologies are also helping in risk management as compared to claims management.
Role of Chief - Customer Service, Technology and Operations in Claims Process
As we see businesses evolve due to new advances in technology, the role of senior management in strategic planning has gained utmost importance. Chief technology officer’s (CTO) roles are as much today about technology innovation as much as managing information technology. To respond to the demands of digital business, CTOs are being looked at as visionaries of identifying and adopting new technologies that will help transform traditional business models. CTOs today are spending more time on technology innovation programs at the same time juggling their time on operational needs. Most of the CTOs in insurance organizations today are identifying business problems that can be solved in the fields of Machine Learning (ML) and Artificial Intelligence (AI), Internet of Things (IoT), Telematics / Telemetry, Big Data and Data Analytics, just to name a few. Senior leaders in organizations are more and more becoming key enablers for transforming companies towards a more customer-focused, tech-centric, collaborative problem-solving and agile organization.
One of the core pillars that we at ICICI Lombard believe in is a sharp focus on technology-led innovation. We think of ourselves as a tech company that also does insurance, and our mindset is geared along those lines. Obviously, our journey on those lines continues and technology continues to be our focus area. A lot of the solutions that have been built are not just built by technology or data science teams but by business teams such as underwriting, claims, customer service together with the data science & technology teams. As an organization, we are developing multiple such solutions using this model of co-creation. There has been a significant change in the mindset of the organization and teams are working together in an environment using agile methodologies that helps in developing such solutions in quick time.
Whenever a new idea is generated, a small agile team looks at the core problem that they are trying to solve for their channel or for their customer. Then they come and work with multiple stakeholders and come up with a small solution. For example, the break-in AI solution is a function of a lot of the data that we collected from our Instaspect app. The original idea of the remote inspection using Instaspect was to improve productivity and to increase convenience for our customers and the garages to settle claims where we could not send people speedily for remote services. But from there, the business team came out with an idea that why do not we use some of these processes to underwrite policies when there has been a break-in in terms of the policy period. Traditionally, we would send a surveyor to look at what has happened and then take images and then go ahead and provide a cover if there were no damages in the interim period. The team thought that we could use the same tool, and since we were capturing images for more than 10 years, we could use those images to build an AI/ML solution which could disrupt the current process. This led to the motor break-in AI solution as it stands today.
Newer technologies on the digital front, including Artificial Intelligence and Machine Learning will play a major role in providing innovative solutions from a customer experience standpoint. As consumer expectations and behaviors change, we believe that the insurance industry will continue to change by embracing newer technology, be it through an AI chatbot that acts as a Virtual Insurance Advisor, or an AI detection model that acts as a Digital Claims Adjuster or a ML model that acts a smart underwriter. There will be prolific use of AI, ML and cognitive services that will help address needs such as digital adoption, customer experience management, operational efficiency, underwriting profitability, claims optimization and much more. Specifically, on the claims side, IoT, drones, telematics and wearables will play a higher role in prevention of incidents as compared to traditional claims management. Automated customer service handled through voice and text will continue to aid customers during the claims process and sophisticated natural language processing and natural language understanding algorithms with help identify fraudulent customers.
Consumer and stakeholder behavior changes will continue to drive the operating model of any business. While we have been developing digital means of servicing and distribution since quite some time, the pandemic accelerated the adoption of various tools for consumers as well as stakeholders. Similarly, we expect that remote working including part-time working will help us in increased productivity due to reduced travel time especially in large cities like Mumbai, Delhi and Bangalore. We will continue to invest in new-age technologies, including cloud, AI/ML and IoT, that continue to help develop solutions that cater to the needs of our customers. The ability of organizations to adapt to change amidst changing consumer behavior and expectations, to roll out products and innovations quickly and bring them to market, and to form sustaining and lifelong partnerships will define how companies will be successful in the long term.
