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How Conversational AI Is Improving Claims For Customers and Insurers

By Srini Vinnakota, VP Product, Avaamo

Almost everyone can remember a stressful moment when they needed to contact their insurance company about a claim. In many cases, people call their insurers after difficult life events like a serious illness or a car accident.  While customers want their cases to be handled quickly, they also want to know they will be supported and can get the answers they need. It’s a tough process for both customer and insurer.

Conversational AI  – –  a system that allows customers to have a conversation with a computer via text or telephone — is changing how the claims process works from first call to claim. With conversational AI, insurers can easily handle the increased volumes of calls and inquiries. As a result, the claims process can drop from a typical 72 hours to minutes.

In addition, a virtual assistant is also able to better route questions and inquiries so they are quickly resolved, with the correct advice. The virtual assistant can do all of this while following compliance and security guidelines required by insurance companies and ensuring that claims operating procedures for improved financial results are followed to a tee.

The system also benefits insurance companies, who have to navigate fraudulent claims as part of their daily business.  Conversational AI can ensure insurers are following compliance and security guidelines and enforce strict adherence to detailed claims operating procedures for improved financial results. Here’s how it works, from the first customer interaction with an insurer to a claim.

Fixing The Process From First Interaction To Claim

Fixing the claims process has to start long before members file claims, when a member is wondering which insurance plan to purchase. Conversational AI can simplify policy and plan choices and clarify industry terminology (what exactly is a copay?) Quotes can be generated in minutes rather than days. Once the member purchases an insurance policy, conversational AI can help them understand what they have purchased (Do I need to be pre-approved for a procedure like a colonoscopy? What is my annual deductible?) An informed member is far less stressed when they have to file a claim.

Long after they’ve signed up with an insurer, conversational AI can smoothen the claims process. A virtual assistant can help members locate appropriate claims forms, answer questions about details required in those forms, and ensure forms get submitted to the right place. This process is often much better than talking with a customer representative – long the gold standard in insurance. Sometimes, customer recommendations depend on a representative’s preferences. As a result, recommendations from different channels aren’t consistent and consumers lose confidence.

By helping members track the status of claims and understand when they might get reimbursed for their claims, conversational AI changes the claims process from an adversarial situation to an empathetic conversation.  Ultimately a claim resolved painlessly is a customer retained for life. Additionally, conversational AI can deliver significant financial benefits for insurance companies by eliminating costly errors in the claims forms.

Better Claims Process Can Change An Industry

One industry that has benefitted from a simplified claims process is health care.  One of the world’s largest healthcare third-party administrators wanted to simplify their claims process, cut back office costs and better control indemnity and loss-adjustment costs. A virtual assistant helped by accessing databases to help claims investigators compile detailed reports and providing more consistent claims settlements. The assistant can also identify and flag fraudulent claims.

Claims inquiries were also resolved more quickly. If the virtual assistant was unable to answer the questions, the call was routed to a claim agent. The virtual agent is now able to assist more than three million customers and services claims information across 2,000+ companies.

Conversational AI Outside Of Claims

The claims process is just one business process that has been overhauled through conversational AI. Both banking and finance have also been deployed to help banks serve customers more efficiently. By automating tasks, banks can cut down inbound calls, resources in branch offices and transaction costs by nearly 60 to 70%.  Conventional AI is now making it easy for customers to access their accounts, check their balance, track traders and review monthly mortgage statements. A virtual “personal banker” can also help customers check accounts, analyze spending, and apply for new services, just like you would at your local branch.