'Conversational AI' is reinventing the insurance claims process

This technology allows insurers to offer better customer service and data from the outset.

Ultimately a claim resolved painlessly is a customer retained for life. (Photo: iStock)

Insurance claims is a stressful process. Members don’t remember what plan they purchased and can’t recall their deductibles. They are coming in at a vulnerable and stressful moment — something has gone wrong, like an automobile accident or a serious medical issue, and they are hoping that their insurance company can help. Insurance companies, meanwhile, are burnt by too many fraudulent claims and their first reaction is often a mixture of caution and suspicion. One mistake can affect their bottom line. No wonder empathy gets relegated to the “nice-to-have” list.

Conversational Artificial Intelligence, or a system that allows computers to communicate with people via phone or text in a way that feels authentic, even human, can simplify the claims process for the customers, assure them that the insurance companies are here to help, and answer every question with nary a tinge of irritation. And it can do this while following compliance and security guidelines required by insurance companies and ensure strict adherence to detailed claims operating procedures for improved financial results.  It’s also a huge time saver. With conversational AI, insurers can better process the increased volumes of calls and inquiries. As a result, the claims process can drop from a typical 72 hours to minutes.

Conversational AI is also able to better route questions and inquiries so they are quickly resolved, with the correct advice. Talking with a customer representative isn’t always optimal. Sometimes, customer recommendations depend on a representative’s preferences. As a result, recommendations from different channels aren’t consistent and consumers lose confidence.

The human touch will still very much be a part of the claims process. What conversational AI will do is offer better customer service and data from the outset. These advances are a means to augment, not replace, human capabilities. Here’s how it works.

What can be claimed

Fixing the claims process starts before members file claims, when a member is wondering which insurance plan to purchase. Conversational AI can simplify policy and plan choices, clarify industry terminology (what’s the difference between co-pay and co-insurance?), and generate a quote in minutes. Once the member purchases an insurance policy, conversational AI can onboard the member efficiently and help her understand the what she has purchased (how much deductible is remaining for this year? do I need a pre-approval for endoscopy?). An informed member is far less stressed when they have to file a claim.

How to file a claim

Conversational AI can also help smoothen the claims process itself. By guiding members to the appropriate claims forms, clarifying their questions about details required in those forms, and ensuring that the forms get submitted to the right inbox, conversational AI can make this process a lot less painful for members. Additionally, it can deliver significant financial benefits for insurance companies by eliminating costly errors in the claims forms. Lastly, by helping members track the status of claims and understand when they might get reimbursed for their claims, conversational AI really changes the claims process from an adversarial situation to an empathetic conversation. Ultimately a claim resolved painlessly is a customer retained for life.

Srini Vinnakota is responsible for product strategy, definition, and direction of the Avaamo product portfolio.  Previously, Srini led Product Management for TIBCO tibbr and TIBCO Engage business units at TIBCO. Prior to TIBCO, Srini co-founded a customer insights startup, and held Product engineering positions at Sun Microsystems and Siebel Systems (Oracle). He can be reached via LinkedIn.

The opinions expressed here are the writer’s own.

See also:

5 insurance and artificial intelligence predictions for 2018

5 ways AI and data are transforming the insurance space