How Generative AI Automates Claims Documentation, Emails, and Reporting?

The claims management process has always been affected by the way it is processed and the information gathered about that process. The changing landscape of the insurance industry has changed the way insurance companies process claims by partnering with companies that specialize in AI development services designed to use next-generation AI technologies to create a reliable, intuitive method for managing claim creation, submission, and communication methods. By using next-generation AI, insurers can generate complete, accurate, and compliant documents for their clients using the AI technology rather than human intervention. This means that insurers can process more claims in less time with fewer errors than ever before.

Understanding Generative AI in Insurance Claims

Generative AI allows users to produce or generate text that resembles writing produced by a human as well as summaries, reports, and communications automatically. Unlike traditional AI automation, which utilizes rules-based automation that carries out procedures via predefined scripts; Generative AI interprets context, understands nuances within language, and understands how to utilize any vocabulary or language of any particular industry, allowing for the creation of documents related to claims dynamically. This is of particular significance in the insurance industry, as no two claims are ever alike, and all claims require an understanding of a variety of unique situations, complex Policy Types, and Regulatory Compliances. As a result, Generative AI builds upon the Data of insurance carriers and utilizes External Data Sources for the generation of accurate and compliant results at Scale.

Difference Between Traditional AI Automation vs. GenAI-driven Automation

For traditional automation of claims via AI, companies focus primarily on data extraction, classification, and Robotic Process Automation (RPA) of repetitive processes. It is effective in increasing the processing speed for forms, OCR and structured workflows. However, it cannot create any new or adaptive content nor accommodate for the diversity of scenarios involved in complex claims.

Generative AI is able to develop entirely new textual content which is coherently produced based upon the information retrieved and organized as a coherent whole. This includes the ability to create new claims summaries, inspection reports, and customer emails. It also includes the ability to interactively engage clients through the use of multi-turn conversations, gain an understanding of the context of the conversation and produce Compliance Documentation which supports the ongoing dialogue with the customer.

Challenges in Traditional Claims Communication & Documentation

Some of the biggest pain points for manual claims documentation and correspondence are:

• Claims Adjusters are dependent on doing the majority of the work manually. This means that their efficiency is limited, as they could spend as much as 40% of their time creating notes, emails, and reports when processing claims.
• Claims adjusters’ documentation will have different levels of quality depending on who created it because humans create documents and because people don’t do things exactly the same way every time. Some claims adjusters may not write complete notes on all aspects of a claim, and will therefore miss important information.
• Errors and omissions lead to long delays in processing claims or could result in a compliance violation if critical non-compliance information is missing or incorrectly written.
• Delays in responding to customers’ emails or calls are detrimental to customer satisfaction and can result in customer attrition due to slow turnaround times.
• It is very difficult to maintain accurate records for audits, and most of the time claims adjusters maintain these records manually, so there is a great likelihood for error in these records.
• Because of the numerous ways claims adjusters log information manually, it is very difficult to have accurate real-time visibility into a claim’s lifecycle and to have executive visibility into the status of a claim at any given time.

How Generative AI Automates Claims Documentation?

Intelligent Claims Intake Notes

Generative AI collects information from FNOL (first notice of loss) sources such as audio recordings of phone calls, images of property damage, etc., and then generates simple and clear intake notes that contain pertinent information about the incident in accordance with policy definitions.

Automated Creation of Claim Files

AI can automatically produce an entire claim file that consists of policy information, accident or loss report(s), medical record(s), and adjuster’s comments (as applicable). This file is created so that it can be submitted or reviewed quickly.

Automatically Generate Review Notes

When adjusters perform inspections/interviews, AI will automatically produce customized summaries of those inspections/interviews and provide standardization so that no important information is lost through manual entry.

Automated Reporting of Compliance

Generative AI has the ability to create complete audit-ready reports for every claim; these include the steps taken to complete each claim, a record of what compliance checks were performed, and a record of any communications sent out in support of compliance with applicable regulations.

How Generative AI Handles Emails Automatically?

Automated Email Drafting

Through AI-generated emails, brands can provide personalized responses to FAQs, claims status updates, requests for document copies, and follow-ups, while adhering to consistent brand tone and messaging. 

Context-Aware Replies

AI allows for the creation of context aware emails by utilizing conversations history and using customer information, allowing for the generation of contextually relevant responses in real-time, thus providing faster responses and reducing call volume. 

Smart Email Sorting & Prioritization

AI automatically sorts and prioritizes incoming emails by assigning them a level of urgency or complexity; simple claims can be auto-responded to and any complex or urgent requests will be sent to appropriate specialists. 

Multi-Language Email Support

Global insurers can use AI to draft and translate their emails into multiple languages, so that they can offer financial assistance to all of their policyholders.

How Generative AI Streamlines Claims Reporting?

Auto-Generated Claims Reports

AI automatically compiles and organizes the information needed to create a claim report. This includes complex property damage assessment, as well as injury evaluation, into a digestible format for adjusters, underwriters, or attorneys.

Executive Dashboards & Insights

With executive dashboards and insights, customers can view a full portfolio view of trends, deviations, and key performance indicators (KPIs). With this ability to see these critical metrics, quick decisions can be made on claims.

Real-Time Status Updates

Through our use of technology, we are able to provide real-time claim status updates to customers and internal team members. This has also increased transparency for our customers.

Automated Audit Documentation

Our automated audit documentation service provides a comprehensive record of your claims from start to finish. The documentation is then stored and maintained in one location for ease of access and compliance purposes.

Benefits of Using Generative AI in Claims Automation 

Below are one of the primary benefits of AI in claims automation:

• Adjusters save 40% – 60% of their time with automated-wise narrative notes and communications. 
• All documentation is consistent and eliminates variability, reducing rework.
• A reduction in errors as well as risk of noncompliance due to standardized, audit-compliant content.
• Accelerated triaging, quicker decision making, and communication has led to faster settlement of claims.
• Big Customer Communication at scale increases satisfaction and loyalty.
• Automatic generation of large volumes of comprehensive documentation also improves transparency and audit-readiness.

Real-World Insurance Use Cases

When an insurance company receives its auto claims, it will utilize the following technologies to analyse your photos and verify your coverage on your policy:Automated Repair Assessments for auto claims. Automated Repair Assessments generate a report automatically based on the evidence provided (photos) and the type of coverage for each item.

• Automated Property Claims for damages and estimated remediation plans: Each property claim is reviewed using the same processes as auto claims.
• Health insurance claims: AI-generated Clinical Summary will use physician notes and medical records as the basis of the clinical documentation required for the claims management process.
• Automated communication regarding worker’s compensation claims will take place between the employer and employee involved and the insurer.
• Fraud investigations: Risk flags with detailed summaries will be generated to facilitate fraud investigations.

A3Logics’ Generative AI Solutions for Claims Management

Through custom model creation programs, A3Logics, a reliable Gen AI Development Company,  is creating generative AI (GenAI) to support the claims management process by providing clients with:

• Custom model creation programs tailored to the client’s specific language and claims history.
• LLM technology (Linguistics Language Model) covered on a secure platform to provide large-scale document/email automation capabilities. 
• Simple integration with major claims management software, including Guidewire, Duck Creek, Majesco and all legacy systems.
• Multi-modal claim processing capabilities for automating the claims process using text, photos, voice, and video.
• Data Compliance in accordance with HIPAA, ISO 27001, SOC 2 standards, and
• Continuous improvement of AI models, driven by constant feedback and real-time and newly-generated data.

Final Thoughts

The use of Generative AI in the area of claims documentation, email correspondence and reporting is changing how these functions are currently being completed. Prior to the use of AI, manual input into claims documentation was a long and expensive process requiring many hours to complete. Generative AI automates the functions of these processes, which has been proven to deliver more accurate results in a much shorter time than was previously attainable. 

As a result, claims can be settled much faster and there is an increased ability to prepare for audits. In addition to providing the best customer experience possible through the use of AI in their Underwriting Division, Insurers can save on their operating costs by using AI and then integrating the use of AI into their overall claim operations. Insurers can use AI Solutions from a trusted AI development company to ensure that their AI Solutions are developed specifically for their business needs and are compliant with industry standards and maintain the integrity of their claims operations as the digital insurance market continues to advance. 

Using Advanced Insurance Software Development Services from a trusted vendor enables businesses to have measurable benefits and establishes AI as an integral part of a modern strategy for automating claims.