Global firm lifts lid on automated claims solution
“This is something EXL strongly believes in. So, it’s not just technology for the sake of technology, it is not just digital for the sake of digital, it is data led thinking and digital as a business model. One of the sectors that is making it all real is the insurance space,” he said.
The last five years of expansion in the Australian market, Bhola said, have hinged heavily on the market appreciating EXL’s commitment to data-led digital transformation “with a very insurance centric lens.”
“Insurance has been the bread and butter for EXL for the last two decades,” he added.
The company aims to provide solutions to the fundamental questions insurance companies are asking about their end-to-end operations including the claims process.
“How are we ensuring that my [the insurer’s] whole claims process is optimal in nature and working as I designed it to be, as I want it to be, and as it should be? Right?” said Bhola.
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One of EXL’s offerings is called Smart Audit and helps insurers automate the end-to-end quality process in their claims operations.
“What we have is an AI-powered automated claims quality solution to drive consistent and compliant claims operations for better customer experience and for preventing any financial leakage,” he said.
“We call it Smart Audit and what it helps insurers do is intake all the claims information and data, whether it was a claims call that happened, whether it was the claims notes that were prepared by the claims agent, and analyse it against a standard set of rules and give a quality score to the claims process,” he added.
Bhola said this is powerful because in more manual claims management systems it’s only possible to quality audit about 10 to 15% of the claims.
“If it’s a manual process there is only so much one person can measure, right? With automation you can analyse 90 to 95% of that information which means you’re able to understand what customers are saying, what is happening in the claims process and then take proactive action if things aren’t heading in the right direction during the claims process,” he said.
This Smart Audit’s scoring is based around quality parameters.
“Those parameters could include aspects like timely customer communication, correct supplier payments, proper coverage verification including many other factors,” Bhola said.
Depending on the size of the insurance company and their claims quality process, he said, there could be few hundred to a few thousand manual checks in place which could be automated using this solution.
“The scoring that I’m talking about is aggregating the parameters, because the system has automated them,” he said.
The information is aggregated and scored using the insurance company’s own models.
“It can come up with a score to say, ‘This is probably 3.5 on a 5 point scale when it should actually be 4.2.’ So it’s giving you that comfort level through the downstream reporting,” he said.
“What that means, and where this is powerful, is that your whole behaviour, in this case the insurer, is changing from reactive to proactive,” he added.
The system needs to be customized to the particular insurer’s claims environment.
“This is not something which you can just take and plug in. Insurers have to customize this smart audit for their environments and processes,” he said.
Bhola said one way this solution can be particularly useful is to help insurers understand and identify claims issues early on that might possibly escalate to a complaint later.
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“If, during a claims process, there are multiple types of claims and not all the claims outcomes are what people are expecting, or the experience is not what people are expecting – but if, during the early stage of the claim, the system can actually give you an idea that there is something here which is low score that can possibly lead to a complaint, you may want to flag it and see how you want to fix it,” he said.
Bhola said an insurance agent can then take corrective action or at least have another look at the claim and the issue.
“What has happened is that you have captured the information and you’ve got the data point in your hands to actually make that informed judgement,” he said.
Bhola believes claims solutions like these set EXL apart from the competition.
“I believe so. This is very different because this is insurance-led and the investment in the AI models in there is based on the way we used to manage quality operations. It’s something that a lot of insurers locally are showing an interest in,” he said.
However, he said it’s not the only trick in EXL’s claims operations model.
“Our solution for claims intake is another strong area where we use AI/ML-driven content extraction particularly on turning unstructured into a structed data format like in claims notes. It is not only solving the efficiency problem, what it is also doing is giving you precious amounts of new data that you were not earlier looking at – and imagine what you can do with that data,” he said.
