Transforming Claims Management with AI

A leading insurer facing a rapid surge in demand, sought solutions to optimize claim costs, enhance efficiency in claims processing, improve turnaround times (TAT), and elevate customer experience. The goal was to sustainably manage a growing volume of cases year-over-year.

i3 Solution

Implementing an innovative AI-driven approach, i3 tackled these challenges comprehensively:

AI-Powered Document Parsing

Leveraging AI to extract 350 data points from claim documents, enabling rapid processing and analysis.

Real-Time Billing Validation

Utilizing AI for validation of billed items against established benchmarks, ensuring accuracy and compliance.

Provider Tariff Benchmarking

AI-driven comparison of prices across 10,000 providers' tariffs, facilitating fair and efficient cost assessments.

Invoice Item Price Comparison

AI-enabled comparison of 50 claim invoice items against 10,000 tariff items, streamlining pricing accuracy & transparency.

Results Achieved

Customer Experience (CX) and Turnaround Time (TAT)

Real-Time Processing

‍Claim approval TAT reduced to an impressive 30 minutes, enhancing customer satisfaction and operational efficiency.

Operational Efficiency

Achieved a significant 30% reduction in operational costs through streamlined processes and automated validations.

Accurate Decision Making

Identification of Non-Payables

AI accurately identifies non-payable items and excess billing, ensuring fair and precise claims adjudication.

Automated Feedback

Automated feedback loops provide concise summaries of deductions, enhancing transparency and communication with stakeholders.

Fraud Prevention and Cost Management

Automated Fraud Checks

Implemented robust fraud and abuse detection rules, preventing 2-5% of claim losses through automated validations and rule-based deductions.

Conclusion

By harnessing AI-driven solutions, our client not only met but exceeded their operational goals. The transformation of claims management processes resulted in unparalleled efficiency gains, substantial cost savings, and elevated customer satisfaction. i3's integrated approach continues to empower the insurer to adapt and thrive in a dynamic market landscape, setting a new standard for claims processing excellence.
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This case study highlights how strategic implementation of AI technologies can drive transformative outcomes in the insurance sector, paving the way for sustained growth and enhanced service delivery.