AmTrust Financial Services CIO and COO, Ariel Gorelik shares their transformational story of leveraging AI technology with omni:us – and achieving 75% automation of incoming claims information getting attached to existing claims files.
A mid-sized insurer wanted to automate the coverage verification process for high-frequency claims. omni:us empowered the highly manual claims coverage check process to automate the process for low-mid complex high-frequency claims.
Inefficient manual process of checking the coverage on high-frequency and low to mid complexity claims
Lengthy and ambiguous check results in numerous additional status request by customer
Complex landscape of product generations and terms/conditions results in frequent false manual coverage decisions resulting in increased leakage
Redeployed staff from manual and time-intensive tasks to more sophisticated, customer-facing work
Increased ratio of black box processing in the claims handling process reducing overall claims handling costs and end-to-end process time significantly by applying automation procedures
Decreased leakage potential significantly by increased identification of claims with valid rejection reasons
Reduce amount of interactions with claimant for high volume / low complexity claims
Consolidated terms/conditions and policies of various product generations to be digitally available
Extracted relevant criteria from the policy and the terms and conditions (e.g. insured objects and values, exclusions)
Trained the AI to determine relevant coverage check details from underlying terms/conditions and policies database
Automated decision based on matching provided claim notification information (e.g. invoices, damage descriptions) and the trained conditions
Automated propagation of AI decision directly into claims process management system to trigger relevant next interaction / information steps
Detect Claim type
Identify Policy match
Extract relevant information
Structure cost items
Group costs by benefit type
Categorize losses by peril
Enrich claim with identified risk exposures
Pre-conditions of policy
Validate coverage conditions
Identified rejection reasons
Cost adjustment due to coverage exclusions & limits
Detect information gaps & information requests
Straight through processing in 4 essential steps. Supercharge your claims process, from FNOL to resolution.
Our mission is to enhance insurance industry processes and workflows by simplifying the claims handling life cycles. omni:us understands the value of automation by identifying key processes to shorten cycle times, enhance customer expectations, increase employee satisfaction, and improve data integrity to create better outcomes in the overall claims handling process.