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.
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.
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.
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.
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.
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.
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.
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.
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