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How Behavioral Psychology is Fixing Modern Insurance Claims

3 minutes, 56 second read

Human Behavior is inherently hard to predict and mostly irrational. Infact, this irrationality is often overlooked because it offers no meaningful insight or patterns behind our motivations. 

In the early 70’s, Israeli-American economist Daniel Kahneman challenged the assumption that humans behave rationally when making financial choices. His research explored the fundamentals of how people handle risk and display bias in economic decision-making. He would later be awarded the Nobel Prize for his pioneering work which provided the basis for an entirely new field of study called Behavioral Economics

Standard Economics assumes humans behave rationally, whereas Behavioral economics factors in human irrationality in the buying process.

Along with another scientific approach to studying natural human behaviors (Behavioral Science), both these fields became particularly useful to the financial industry early on. By understanding the deep seated motivations behind people’s choices, a specific interaction can be designed to influence an individual’s behavior — also known as behavioral intervention.

By finding meaningful patterns in Big Data, usually performed by a data scientist, businesses are able to leverage analytics and behavioral customer psychology. The outcomes of these insights can help business owners learn about the customer’s true feeling, explore behavioral pricing strategies, design new experiences and retain more loyal buyers. This is why Behavioral Scientists have become highly sought after over the last decade. 

The Rise of the Behavioral Scientist

Take for instance Dan Ariely, who is a Professor of Psychology & Behavioral Economics at Duke University, and also serves as the Chief Behavioral Officer of Lemonade — the World’s biggest Insurtech. Ariely observes that human behavior is ‘predictably irrational’ and constantly exhibits ‘self-defeating’ characteristics. There is a lot of value in studying these behaviors, for many organizations, to encourage positive ones, dissuade dishonesty and improve the underlying relationship.

The ‘dissuading dishonesty’ part is particularly useful for Insurance carriers. For a business that fundamentally deals with both people and risk, Insurance is endlessly plagued by fraud. Insurance fraud losses were estimated around $80B in 2019 alone. On the other hand, legitimate claim instances can at times be overlooked due to the lack of evidence or nuances in the finer policy details. 

To combat fraud during the claims process, Ariely added a simple ‘honesty pledge’ agreement before the beginning of the claims intimation process. A customer signs the digital pledge, and is then asked to record a short video explaining the incident for which they are requesting the claim.

The process seems naive but it’s backed by tons of data and science — a byproduct of decades of research work put into psychology and behavioral economics. 

So, How are claims being driven by data science?
How do insurers capture honesty from their customers?
The answer is priming.

By enforcing an honesty pledge, Lemonade was able to bring down the likelihood of fraudulent claims being intimated for. In other words, they made it harder for customers to lie. The hypothesis that works is: Don’t blame people for mistakes in decision making, it’s on the designers of the system

After the customer got done with their video recording, Lemonade ran 18 anti-fraud algorithms against the claim to check its veracity and a payment was made in a few seconds. 

Behavioral Priming in Insurance

Behavioral work is built on strong academic research that identifies aspects that influence the  buying process. ‘Nudges’ are a perfect example of behavioral priming at work. Nudge theory (a concept within Behavioral Science) identifies positive reinforcement techniques as ways to influence a person’s behavior and ultimately their decision-making.

For example, according to a study published in the Journal of Marketing Research, research subjects who were shown an aged image of their faces allocated twice the amount to their retirement savings when compared to people who were shown images of their current younger selves.

In this case, the ‘nudging’ technique was effective in driving retirement planning behavior among the test group. 


Source: Centre for Financial Inclusion

Behavioral Economics also stipulates that once you start doing something, you are more likely to continue doing so. This is how Netflix uses subtle nudges on their platform, where after each episode a prompt asks if you would like to continue watching the show.

Deriving New Value

Swiss Re’s Behavioural Research Unit outlines five promising areas where behavioral economics can create new value for insurers.

Digital businesses are gradually realizing the limitations of human and machine systems without any real intelligence or computing power behind it. Between human prone errors and the scalability challenges of traditional technologies, a new mechanism is required to learn and adapt better. 

Behavioral Science interventions in insurance can help carriers align their strategies with the true needs of their customers. Using the insights posited from advanced machine learning models, the right behavioral intervention can bring about changes to real-world insurance demand behavior that closely matches the benchmark model.

Also read – how InsurTech beyond 2020 will be different?

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Enhancing digital patient experience with healthcare chatbots

5 minutes read

Chatbots are fast emerging at the forefront of user engagement across industries. In 2021, healthcare is undoubtedly being touted as one of the most important industries due to the noticeable surge in demand amid the pandemic and its subsequent waves. The Global Healthcare Chatbots Market is expected to exceed over US$ 314.63 Million by 2024 at a CAGR of 20.58%.

Chatbots are being seen as those with high potential to revolutionize healthcare. They act as the perfect support system to agents on the floor by providing the first-step resolution to the customer, in terms of understanding intent and need, boost efficiency, and also improve the accuracy of symptom detection and ailment identification, preventive care, feedback procedures, claim filing and processing and more.

At the outset of the COVID-19 pandemic, digital tools in healthcare, most commonly chatbots, rose to the forefront of healthcare solutions. Providence St. Joseph Health, Mass General Brigham, Care Health Insurance (formerly Religare), and several other notable names built and rolled out artificial intelligence-based chatbots to help with diagnostics at the first stage before a human-human virtual contact, especially while differentiating between possible COVID-19 cases and other ailments. The CDC also hosts an AI-driven chatbot on its website to help screen for coronavirus infections. Similarly, the World Health Organization (WHO) partnered with a messaging app named Ratuken Viber, to develop an interactive chatbot for accurate information about COVID-19 in multiple languages. This allowed WHO to reach up to 1 billion people located anywhere in the world, at any time of the day, in their respective native languages.

For Care Health Insurance, Mantra Labs deployed their Conversational AI Chatbot with AR-based virtual support, called Hitee, trained to converse in multiple languages. This led to 10X interactions over the previous basic chatbot; 5X more conversions through Vanilla Web Experience; Drop-in Customer Queries over Voice Support by 20% among other benefits.

Artificial Intelligence’s role in the healthcare industry has been growing strength by strength over the years. According to the global tech market advisory firm ABI Research, AI spending in the healthcare and pharmaceutical industries is expected to increase from $463 million in 2019 to more than $2 billion over the next 5 years, healthtechmagazine.net has reported. 

Speaking of key features available on a healthcare chatbot, Anonymity; Monitoring; Personalization; collecting Physical vitals (including oxygenation, heart rhythm, body temperature) via mobile sensors; monitoring patient behavior via facial recognition; Real-time interaction; and Scalability, feature top of the list. 

However, while covering the wide gamut of a healthcare bot’s capabilities, it is trained on the following factors to come in handy on a business or human-need basis. Read on: 

Remote, Virtual Consults 

Chatbots were seen surging exponentially in the year 2016, however, the year 2020 and onwards brought back the possibility of adding on to healthcare bot capabilities as people continued to stay home amid the COVID-19 pandemic and subsequent lockdowns. Chatbots work as the frontline customer support for Quick Symptom Assessment where the intent is understood and a patient’s queries are answered, including connection with an agent for follow-up service, Booking an Appointment with doctors, and more. 

Mental Health Therapy

Even though anxiety, depression, and other mental health-related disorders and their subsequent awareness have been the talk around the world, even before the pandemic hit, the pandemic year, once again could be attributed to increased use of bots to seek support or a conversation to work through their anxiety and more amid trying times. The popular apps, Woebot and Wysa, both gained popularity and recognition during the previous months as a go-to Wellness Advisor. 

An AI Wellness Advisor can also take the form of a chatbot that sends regular reminders on meal and water consumption timings, nutrition charts including requisite consultation with nutritionists, lifestyle advice, and more. 

Patient Health Monitoring via wearables 

Wearable technologies like wearable heart monitors, Bluetooth-enabled scales, glucose monitors, skin patches, shoes, belts, or maternity care trackers promise to redefine assessment of health behaviors in a non-invasive manner and helps acquire, transmit, process, and store patient data, thereby making it a breeze for clinicians to retrieve it as and when they need it.

Remote patient monitoring devices also enable patients to share updates on their vitals and their environment from the convenience and comfort of home, a feature that’s gained higher popularity amid the pandemic.

A healthcare chatbot for healthcare has the capability to check existing insurance coverage, help file claims and track the status of claims. 

What’s in store for the future of chatbots in Healthcare? 

The three main areas where healthcare chatbots can be particularly useful include timely health diagnostics, patient engagement outside medical facilities, and mental health care. 

According to Gartner, conversational AI will supersede cloud and mobile as the most important imperative for the next ten years. 

“For AI to succeed in healthcare over the long-term, consumer comfort and confidence should be front and center. Leveraging AI behind the scenes or in supporting roles could collectively ease us into understanding its value without risking alienation,” reads a May 2021 Forbes article titled, The Doctor Is In: Three Predictions For The Future Of AI In Healthcare. 

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