SENTIENT Case Study

Application of ML in faster and more accurate claims processing

Customer

Japanese Life Insurance Company

Industry

Insurance

Function

Claims Processing

Problem

The company’s claims processing team was the most labour-intensive and therefore its largest cost center. It took the team an average of two weeks to process each claim, and the decision was based on a loose set of rules combined with personal experience of the claim-processor. The accuracy of the decisions was also suspect.

Solution

The company adopted an AI application to boost operational efficiency in its medical claims department. The application was responsible for calculating accurate pay-outs based on details of the administered procedure, period of hospitalization, medical history and insurance conditions. In order to do this, the application accessed medical certificates, hospital bills and internal claims history files and scans of the insurance contract for any special coverage clauses to prevent payment oversights. The pay-out was thus calculated and sent for approval to a staff member.

Result

The application improved productivity by 30% and yielded improvements in accuracy of payouts. The company saw a return on investment within two years through annual savings of $1.3 million. The customer satisfaction was increased through reducing lead time of pay-outs.

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Email : info@unitx.tech

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