Insurance Industry Solution Presentation


Published on

Costs for claims processing and resolution are on the rise, as providers increasingly struggle to combat fraud. Join Attensity’s James Purchase, Senior Director of Industry Solutions, to learn how Attensity’s Insurance Industry Solution helps insurance providers find cost-effective ways to identify fraudulent claims and customer pain points, improve competitive rankings, win new business and retain loyal customers.

  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Insurance Industry Solution Presentation

  1. 1. Attensity Webinar SeriesCustomer Experience Management in the Insurance P&C IndustryWith James Purchase, Senior Director of Industry Solutions, Attensity#AttensityWebinar
  2. 2. Agenda Introduction to Attensity Insurance P&C - High Loss Ratio Challenge Insurance P&C - Benefits of Unstructured Claims Analytics Use Cases:  Detection of Fraudulent Claims  Accurate Identification of Subrogation  Enhanced Claims Analysis  Survey Verbatim Analysis  Member/Non-Member Review Analysis  External vs. Internal Review Analysis  Social Media Buzz & Sentiment Insurance P&C Solution Deliverables – Summary & Conclusions Q&A
  3. 3. About AttensityHelp the world’s leading brands leveragecustomer conversations as a business asset.No matter where they take place:social media • blogs • surveys • call center notes • review sites • emails • more 10+ years of experience in Text Analytics/CEM 7 patents in natural language processing 500+ installations worldwide World’s largest NLP development group
  4. 4. We Work with the World’s Leading Brands Customer Service BI Text SCRM Analytics VOC
  5. 5. Attensity Social Analytics and Engagement SuiteReal-time annotated social ATTENSITY COMMAND CENTERmedia data feed: 75+ millionsocial and online sources ATTENSITY PIPELINEPlus internal sources: emails,surveys, CRM notes, etc Enriches and tags the data Extracts people, ATTENSITY ANALYZE ATTENSITY RESPOND Deep sentiment, root cause analysis and trending Social customer engagement solution places, things, events
  6. 6. Insurance Industry Solution Built on Attensity Analyze: First Text Analytics Solution Designed for Business Users One of a series of industry solutions Includes out of the box:  Industry specific Dashboards, Reports, Categories, Topics  Patented semantic analysis for extracting detailed insights from text  Sentiment and root cause analysis  Trend analysis  Continuously updated social media feed & market intelligence  Point and click wizard for creating custom reports & dashboards
  7. 7. P&C Industry - High Loss Ratio Challenge Most property and casualty (P&C) insurers ended 2011 with dismal financial results, with many insurers experiencing year-over-year deterioration. Carriers are looking for ways to correct the High Loss Ratio!
  8. 8. Insurance P&C - Benefits of Unstructured Claims Analytics 80% of all claims data is unstructured, which makes spreadsheet analysis of standard data ineffective. Claims analysis of unstructured data can drive major financial improvements in areas such as:  Fraud  Subrogation  Provider Network Management Source:
  9. 9. Use Case: Improving Detection of Fraudulent Claims UK National Fraud Authority estimates £2 billion in fraud annually. 10% of all US P&C claims are fraudulent – representing over $40 Billion of cost to the industry Industry best practice finds fraud in 1 to 3% of claims The Claim Adjuster workforce is aging: 70% is over 45 years old – knowledge and experience is leaving the industry Average claim settlement times are too long, driving loss and adjustment expense higher
  10. 10. Use Case: Improving Detection of Fraudulent Claims Claims Administration Straight through processing Dictionaries Appropriate Claim Examiner  Workers Compensation  General Liability  Auto SIU Claims Database All data is Claims are Text Sources All claims are fused analyzed assigned to 1 Intelligent Workflow Social Media together of 4 tiers Email Supervisor Other
  11. 11. Use Case: Improving Detection of Fraudulent ClaimsFused claim records:Claims enter the funnel using filteringoptions to identify claims to be processed Tiered Claims claims in this tier show no suspicion and Tier 1 should be fast tracked No Suspicion Tier 1 claims in this tier show minimal signs of Tier 2 suspicion and may require analysis Tier 2 Score claims in this tier show stronger signs of Tier 3 Tier 3 suspicion and should be analyzed Tier 4 High Suspicion claims in this tier are highly suspicious and Tier 4 should be referred to SIU Actionable Claims
  12. 12. Use Case: Improving Detection of Fraudulent Claims Reduced costs Addressing fraudulent claims earlier in the process reduces the overall claims cost. Training Text analysis uncovers inconsistent use of red flags across claim examiners and identifies training opportunities. Improved regulatory Analysis of text identifies suspicious claims not compliance reported to state agencies. Knowledge capture Allows for the capture of fraud intelligence and the consistent application across claims. Provides a hedge against loss of knowledge .
  13. 13. Use Case: Improving Detection of Fraudulent Claims Provides a cumulative view of claims. In this example over Drilling into this claim which is 50% of claims are a Tier 3 we see the presence of characterized as : 4 indicators! Neck, Back, Shoulder, Arm & Knee injuries! Claims Details provides additional information such as Given that this is a Tier 3 claim Gender, Age, Health Profile… we can update the status as “Sent to SIU” Many Red Flag Indicators are publically known but many are specific to a product/carrier and others continue to emerge! The presence of multiple Red Flag Indicators can lead toshows a breakout of the This Fraud “Tiers”. The more highest occurring flag indicators present theindicators. more suspicious the claim!
  14. 14. Use Case: Accurate Identification of Subrogation Subrogation is the process whereby one insurance company, whose customer was not at fault, recoups paid claims from the company of the individual responsible for the accident. Each individual state has unique rules and regulations around what constitutes “fault.”! For most insurance organizations, subrogation is something less than a science. Goal to quickly ascertain high priority to low priority of successful subrogation
  15. 15. Use Case: Accurate Identification of Subrogation Attensity extracts Entities like BODY_PART, CLAIM_ROLE & INJURY but what about Attensity also gets to Subrogation and Root relationships in text? Cause: “insured vehicle : broadside : other vehicle” “burn from airbag”
  16. 16. Use Case: Enhance Claims Analytics Claims Supervisors can glean intelligence about time- intensive steps and consider ways of improving claims processing efficiency
  17. 17. Use Case: Enhanced Claims Analytics Older claims may involve multiple Adjusters. Individual Claims Adjusters can review chronological order of claims
  18. 18. Use Case: Survey Verbatim Analysis Members can provide feedback on themes such as Service, Attrition, Product, Brand Indirectly there may be feedback on “Service Provider Networks” including  Body Shops  Auto Repair Facilities  Vehicle Rentals  Legal Services  Medical Providers.
  19. 19. Use Case: Survey Verbatim AnalysisRelatively higher Negative Negative feedback on Propertysentiment towards Property Poor communication/Follow-Up claims centered on “PolicyClaims process versus Auto is common to both lines of Coverage complaints”, “PoorClaims process business Explanations” “Claim Process Slow” Auto Claim complaints are more centered around “Appraisals/Estimates Inaccurate” Common Positive Sentiment towards “High Or Increased Rates”lines of business includes: both “Performed Job Well” “Helpful, Responsive” Can review surveys for feedback on Service Network Providers. Based on quantity of feedback, there may be opportunities for expanding networks…
  20. 20. Use Case: Member/Non-Member Review Analysis Within most industries Member/Non-Member reviews are an increasingly important component of “Word of Mouth” marketing Review sites controlled or facilitated by a carrier may tend to be more positive in nature! Reviews of USAA insurance products and services were analyzed by 3 lines of business: Auto, Home and Rental.
  21. 21. Use Case: Member/Non-Member Review Analysis Reviews for Home insurance is significantly more Negative than Auto or Rental Lots of Negativity towards “premium”
  22. 22. Use Case: Member/Non-Member Review Analysis Drilling down into Auto Reviews we actually see some Churn Threats! These reviews can be routed and responded to via Attensity Respond!
  23. 23. Use Case: External vs. Internal Review Analysis Specifically members/non- External reviews show more members are complaining more negativity about Service issues Carriers that have a Social Media Engagement strategy are better placed to engage with members!
  24. 24. Use Case: Social Media Buzz & Sentiment Despite a lot of Negativity towards Marketing (commercials), YTD there is more positivity This report tracks Share of Voice across Carriers This report tracks overall This tag cloud track overall Sentiment across carriers… specific complaints across industry.
  25. 25. Use Case: Social Media Buzz & Sentiment These reports provide a high level and detailed view of Sentiment across the entire industry!
  26. 26. Use Case: Social Media Buzz & Sentiment Through the use of Hotspots, Attensity can track new Product Launches, Marketing Campaigns , Customer Service and many other themes
  27. 27. Use Case: Social Media Buzz & SentimentDistribution of Social MediaContent Type By Carrier!
  28. 28. Use Case: Social Media Buzz & Sentiment Sentiment by Social Media Channel!
  29. 29. Insurance P&C Solution – Summary & Conclusions Packaged Insurance P&C Dictionaries, Topics, Categories, Reports & Dashboards Tiered-Fraud approach – tiering of claims based on years of human intelligence versus statistical and probability-based scoring Higher degree of accuracy – industry leading Text Analytics engine enables a scoring approach that significantly reduces false positives and negatives Easily configurable dashboards Over 100 OOB dashboard reports across Fortune 500 Carriers Daily extractions of all Social Media data (real-time available if needed)