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The role of AI in enhancing claims experience for Insurance customers

4 minutes, 21 seconds read

Insurance customers are most vulnerable when they file a claim. Be it life or general insurance, claims are filed in distress. This is also a critical moment for Insurers. The claims experience they deliver determines customer loyalty, which also influences referral customers in the long run. In the Insurance industry, where products and pricing among the competitors are almost the same, customer experience becomes the main differentiator. 

However, the catch is — we live in a multimodal world, which is an amalgamation of different generations and their unique preferences. Thus, Insurers need to comply with the capricious demands of different sets of policyholders. How?

AI can enhance the overall claims experience for your customers through faster and automated claims support, and multichannel integration. Let’s delve deeper into the details. 

AI in claims management cycle

According to the State of AI in Insurance report, 74% of the Insurance leaders believe that the adoption of AI is most prominent for claims processing; followed by underwriting & risk management (48%), fraud prevention (39%), and customer and agent onboarding (22%).

AI has the potential to deliver a zero-touch integrated claims experience from the first notice of loss to the final settlement. 

Source: The State of AI in Insurance 2020

Delivering faster and integrated claims experience requires redesigning the entire claims journey from the customers’ point of view; where each touchpoint requires seamless digital interactions across the entire claims management cycle. It also involves optimizing back and front-office processes with intelligent automation. 

Typically, claims experience for customers starts with the first notice of loss and involves certain stages for final settlement. Mckinsey reveals that nearly 80% of claims filed are manually reviewed by adjusters. The four main milestones in the claims settlement journey (as illustrated in the diagram above) include — first notice of loss, loss assessment, fulfillment, and settlement. AI can enhance customer experience at each of these stages. 

  • First Notice of Loss: Here, the loss has occurred. The customer is already devastated. Making help available as quickly as possible and in the easiest possible way, Insurers can ensure a healthy experience in an otherwise panicking situation. AI technologies like NLP chatbots, voice-assisted services, and digital claims recording can help in providing instant support. Also with machine learning-based fraud detection algorithms, Insurers can prevent fraud and further resources involved in assessment and fulfillment at the very beginning. 
  • Loss assessment has been a cause of delays in traditional insurance claims processes. Because, Insurers used to manually check damages, optimum repair costs, and then finally calculate the settlement amount. The longer it takes for loss assessment, the higher the brand value declines for the customer. With automated triage & claims inspection and remote inspection & evaluation, loss assessment can be made in a near-real-time.
  • During the fulfillment process, AI can help insurers with automated claims validation and digital supplier management.
  • Immediate settlement is what customers seek. With settlement automation and an automated accounting system, Insurers can provide instant settlement. For instance, Lemonade, a peer-to-peer insurance provider is able to settle claims in less than a minute!

Suggested read — 

AI can enhance claims experience in multichannel Insurance models

Insurers have to deal with a broad spectrum of customers. There are Maturists — the technology non-users, then Boomers — who have just now started using technology, Millennials — the digital immigrants, and Gen Z — the digital natives. 

These different sets of customers not only have different policy preferences but also the choice of platform they use. For instance, Maturists still rely on face-to-face communication with customer representatives to address their claims concerns. Whereas, Millennials want every resolution at the tip of their fingers. 

The proliferation of communication channels has complicated Insurance carriers’ expertise in delivering experiences. But, the generation gap will always remain. Accenture’s recent study reveals that nearly 89% of customers use at least one digital channel to interact with their brand. Surprisingly, only 13% of customers say — the digital and physical experiences are aligned. Therefore, the best approach is to adopt a technology that binds well with the requirements of the past, present, and future. 

AI and Machine Learning technologies make it possible to implement omnichannel and multichannel strategies at scale. However, there’s a fine line between omnichannel and multichannel communication models. Given the above case of different customer demographics, let’s confine to the benefits of AI in multichannel integrations.

  • AI technology enables Insures to precisely understand different personas, policy preferences and customer journeys.
  • Based on customer personas AI can augment the Insurance adjusters, claims managers, and other stakeholders’ knowledge about the claimants and their current situation. Thus, allowing them to address the circumstances with empathy.
  • By capitalizing on the insights obtained through AI, Insurance decision-makers can redesign their IT infrastructure to scale customer experiences.

The crux

In the future, AI will play a crucial role in the completely automated end-to-end claims settlement process. This will bring a two-fold advantage — Insurers will be able to free human resources to provide emotional support to the customers. And, with the instant resolution, customers will get a high-touch claims experience.

We specialize in customer experience consulting with domain expertise in modern Insurance and InsurTech solutions. Drop us a word at hello@mantralabsglobal.com for claims experienced focused products and solutions.

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MantraTalks Podcast with Parag Sharma: Delivering Digital-first Health Experiences for Patient Care in the New Normal

6 minutes read

The healthcare industry took the brunt of the Covid-19 pandemic from the very beginning. It was, and still is, a humongous task for hospitals to deal with the rising number of COVID patients as well as handling the regular consults. 

To delve deeper into the state of healthcare in the COVID times, we interviewed Parag Sharma, CEO, Mantra Labs Pvt Ltd. Parag shares his insights on how technology can help in delivering digital-first health experiences for patient care in the New Normal.

Parag is a product enthusiast and tinkerer at heart and has been at the forefront of developing innovative products especially in the field of AI. He also holds over ten years of experience working in the services line and has been instrumental in launching several startups in the Internet & Mobile space. His rich domain expertise and innovative leadership have helped Mantra climb to the top 100 innovative InsurTechs in the World – selected by FinTech Global. 

Catch the interview:  

Connect with Parag- LinkedIn

COVID-19 and Its impact on Healthcare Organizations

Considering the COVID situation, according to you how has COVID-19 impacted the IT & service operations among healthcare organizations?

Parag:  Since the onset of COVID-19, the healthcare sector has been deeply impacted. Institutions are facing a serious crunch in manpower. IT support systems which were usually manned and managed by a large team of IT professionals are not available in the same strength. Resource allocation’ is one of the biggest concerns due to physical and mental exhaustion of the healthcare workforce. 

Hospitals are facing issues such as operational disruption due to staff quarantine, supply-chain delays and sudden decline in patient footfalls, difficulty in sustaining fixed costs, etc. People are not comfortable getting out of the safety confinements of their homes due to the rising risk of getting infected with the virus. Hospitals will have to reassess their future strategy and budgets in light of the uncertain economic situation.

Preparing for the Future

What can hospitals do to ensure the continuity of their customer-facing operations in the wake of a second Pandemic wave?

Parag: There are many things that hospitals can do to manage themselves in this hour of crisis. Being more digital than what they are would be one step forward for all of them. They can bring their IT systems to the cloud so that the person can access data and manage their work remotely. They can enable their patients to book appointments and enquire about services through apps and chatbots which won’t require them to call the reception or come to the hospital. These are some of the services which hospitals can provide to their customers with minimum physical contact. 

Related: Manipal Hospital’s move to a self-service healthcare mobile application

Hospitals can extend Telehealth services to their patients. Recently, telehealth has proved to be useful especially when there is asymmetry between the number of patients and healthcare providers. I think it will be very useful for healthcare institutions to deploy telehealth solutions to provide medical facilities to people who have so far been outside the benefits of healthcare.

New Expectations in Health Experiences

Is consumer behavior defined by the ‘new normal’ going to change the way we access healthcare from this point on?

Parag: Yes, people will expect a completely different way to access healthcare services from now on. Hospitals should gear-up and rise to this occasion. The pandemic has also provided a new opportunity to adopt a completely different approach in the way healthcare is delivered. They always felt that medical care cannot be provided remotely but now this is happening and people are appreciating remote healthcare services. Hospitals and healthcare institutions are convinced that telehealth and remote care will be more successful soon.

Technology in Healthcare can Bridge Operational Gaps

What are the operational challenges, as far as digital capabilities go, that hospitals are facing currently? And, what steps must they take to bridge these gaps?

Parag: Operational challenges are not just digital challenges. But a lot of these challenges can be addressed with technology. For example, Electronic Health Records which hospitals manage within the premises can be moved to the cloud so that the person can access these records on the cloud itself and need not come to the hospital. 

Related: Medical Image Management: DICOM Images Sharing Process

Secondly, if you deploy telehealth and telemedicine solutions, irrespective of where your patients are or doctors are, hospitals can deliver the required care to its patients. You can even extend your diagnostics services to your patients by giving them an application through which they can seamlessly book appointments for consults, diagnostics, or pathological services and resolve their queries, etc. Simply by giving a seamless interface either through bots or applications can go a long way in providing better health experiences to the customers.

Role of Chatbots in Superior Customer Experiences

According to you, what role does chatbots powered by Artificial Intelligence have in the Healthcare CX landscape?

Parag: Chatbots are the simplest example of the implementation of AI-based technology in healthcare. There are a lot of things which bots can do simplistically. For example, if a patient wants to book an appointment with the doctors, instead of going through a complex web applications and interfaces, what if I can simply write “I want to book an appointment with the doctor Dr. XYZ at 4 pm” and the bot can figure out in case the time slot is available with that particular doctor, it will confirm the appointment followed by a payment process if the payment has to be made upfront. 

Apart from this, you can extend your bots to provide e-consultations where doctors can do remote consultations via audio and video features of a chatbot. So there is a huge scope for bots beyond answering routine queries by customers or booking appointments. It does not stop just there. You can extend chatbot functionalities to support functions such as admin, HR, finance, and business process efficiency so that they can provide better services to their customers.

Related: Healthcare Chatbots: Innovative, Efficient, and Low-cost Care

Chatbot Use Cases in Healthcare

Could you tell us some possible bot use cases for delivering better customer experiences to digital health users?

Parag: Apart from booking appointments and resolving customer queries, these bots can conduct remote consultations, internal processes, health symptom checker, out-patient video consultation, second opinion consultation, ordering medicines, psychological counseling & mental wellness, scenario-based risk advice, Heroism Recognition for employees, etc. Also, it can be further extended to help patients enquire about health insurance related queries, and all the interactions between insurance companies and hospitals can be provided to the patient. 

Related: Healthcare & Hospitals Use Cases | Digital Health

The Road Ahead

COVID-19 has forced hospitals to revise patient support strategy with limited operational staff that is bringing every day a new challenge. A way out is to heavily rely on digital innovation.

In India we have a disparity between the no. of healthcare providers and care seekers. Without technology, I don’t think there is any way healthcare institutions will be able to scale to a level where they can provide meaningful services to such a large number of people. Hospitals can invest in setting up an information exchange; making the process as seamless as possible; and removing all possible inefficiencies from the supply chain through technology.

Future growth for hospitals will come from digital technology because patients will opt more for digital platforms. And it is up to hospitals to catch up with the pace at which modern technology is developing. We, at Mantra Labs, have achieved several use cases including hospitals/diagnostic centers that are able to deliver superior health experiences.

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