Search
Profile

Ask your question

Close

What Is Insurance Claims Management?

Insurance claims management is the process of managing a claim from reception to settlement. The insurance claim process works particularly well with machine learning solutions that cut time and costs, leading to speedier resolution of claims to the satisfaction of both insurer and insured.

Details

Why Is It Important to Have a Good Insurance Claims Management Model?

Insurance claims management help insurers acquire customers and provide them with personalized and efficient service. They process claims and detect fraud quickly while underwriting policies even more effectively.

What Internal Data Should I Have for a Good Insurance Claims Management Model?

A good model has data on the customer (like age, sex, medical condition, medical history, etc.), their policy, and claims they made. All data should be stored in one place so that new policy underwriting like policy modifications will consider previous claims.

What External Data is Essential for a Good Model?

Data from apps and sensors provide important information on the individual client, their lifestyle, and geographic area that a good insurance claims management model incorporates. For instance, wearable health device data can provide insurers with a wealth of data they can use to inform their underwriting and pricing processes.

Insurers can also market to health-tracking device users in the general population.

What External Data May Prove Useful for a Good Model?

Any information that provides data about the claim case can help to improve the model and achieve improved results. Data such as weather conditions and the economic situation may also prove useful in predicting insurance claims.

What Are the Main Challenges of This Use Case?

Using AI can make a situation like that of a “black box” where most of the business personnel do not fully understand why or how the predictive model undertook a certain action. As a consequence, the insurance company may lack the ability to document and defend decisions like the claim denials.

Regulators also increasingly press insurance companies to explain the inner workings of their predictive models. This is especially true where models are used in underwriting and the pricing of premiums in order to ensure there have been no discriminatory practices.

Interesting Case Studies and Blogs to Look Into

McKinsey: Insurance 2030: The Impact of AI on the Future of Insurance
R Bloggers: Machine Learning for Insurance Claims

Tangible Examples of Impact

Most insurers recognize the value of machine learning in driving better decision-making and streamlining business processes. Research for the Accenture Technology Vision 2018 shows that more than 90 percent of insurers are using, plan to use or considering using machine learning or AI in the claims or underwriting process.

Insurance Claim Analysis Using Machine Learning Algorithms

Relevant datasets

IBM MarketScan Research Databases

by ibm-the-weather-company

IBM MarketScan Research Databases provides one of the oldest continually-updated collection of health claims data in the USA. Organizations use this data to prove their value to healthcare professionals, insurers, and private individuals.

The data includes drug claims, dental claims, lab results, hospital discharges, and EMR data for millions of people in the country. It also contains workplace productivity data, telling institutions how many workplaces absences they suffer and how many of their healthcare workers suffer disability due to their work. 

4 (1)   Reviews (1)

Demotech Enterprise Risk Management

by

Enterprise Risk Management provided by Demotech optimizes risk management solutions.

0 (0)   Reviews (0)

UrtheCast Sensor Technologies

by

UrtheCast Sensor Technologies is a detector of global change and analysis system.

0 (0)   Reviews (0)

UrtheCast UrthePipeline

by

UrthePipeline is a full managed ground segment pipeline that is used to convert downlinked satellite data into an analytics ready data.

0 (0)   Reviews (0)

UrtheCast Geoanalytics

by

UrtheCast Geoanalytics converts global data into accurate and reliable insights.

0 (0)   Reviews (0)

Similar Data Providers

  • The Arabesque GroupThe Arabesque Group
    5 (1)
    Reviews ()
    Data sets (4)
    Established in 2013, the Arabesque Group is a leading global financial technology company that combines AI with environmental, social and governance (ESG) data to assess the performance and sustainability of corporations worldwide. In addition to their Asset Management consultation service, the groups offers Arabesque S-Ray GmbH and Arabesque AI Ltd. datasets.
  • Black Box Intelligence Consumer Intelligence
    5 (1)
    Reviews ()
    Data sets (0)
    Black Box Intelligence Consumer Intelligence is designed to provide detailed analysis on individual competitor sales and performance data.
  • Home by Vendigi
    4.3 (3)
    Reviews (1)
    Data sets (1)
    Home by Vendigi provides audience data for all things home buyers, remodelers, and sellers. Their data comes from first-party sources like top multiple listing systems (MLSs) major brokers like RE/MAX, Coldwell Banker, Century 21, and Sotheby's. Users of Vendigi's Home data range from home and garden retailers to insurance institutions to telecom companies.