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Next-generation cognitive RPA capabilities in Claims Processing

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Imaginea in partnership with UiPath brings this exclusive webinar, where we will deep dive into the significance of embedding cognitive solutions in your RPA initiatives. We will be walking through how to embed AI into RPA, and evoke judgemental capabilities in data-to-action spectrum. In short, we will be exploring how to achieve end-to-end automation in Claims, using Cognitive RPA.

Listen to our webinar for some new perspectives and interesting insights into the current trends in Cognitive RPA.

Click here and listen to our webinar: https://www.imaginea.com/webinar/next-generation-claims-processing/

You could also write to us at connect@imaginea.com.

Published in: Technology
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Next-generation cognitive RPA capabilities in Claims Processing

  1. 1. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 1 WEBINAR Next-generation cognitive RPA capabilities in Claims Processing
  2. 2. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 2 SPEAKERS Suresh Babu Chief Revenue Officer, Imaginea Suresh drives Imaginea’s business growth through robust sales, marketing, and business strategies. He is a proven leader with a successful track record spanning 20 years, and is known for his ability to build high-performance teams and drive profitability and growth. Sathya Sethuraman Global Leader, Intelligent Automation, Insurance, UiPath Sathya is an insurance industry strategist and thought leader with over 20 years of experience. He is a trusted advisor to Fortune 100 global insurance and financial services enterprises and has led large-scale Digital Transformation initiatives. Sathya brings critical insights to the application of emerging technologies for differentiated customer experiences and operational efficiency. Srivatsan Parthasarathy Principal Architect, Imaginea Srivatsan is a progressive leader, who is known for his expertise in enterprise architecture and solving technology challenges in innovative ways within the given constraints. As a strong believer of continuous learning, he has been responsible for incubating dynamic automation and robotic process automation practice areas for organizational innovation.
  3. 3. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 3 EVOLUTION OF ROBOTIC PROCESS AUTOMATION (RPA) Source: IDC, DeloitteSource: Everest group MARKET ADOPTION Business impact Early stage assisted RPA Unassisted RPA Autonomous RPA Cognitive RPA with AI ▪ Improve productivity ▪ Partial automation ▪ Difficult to scale ▪ End-to-end automation ▪ Easy to scale ▪ Work orchestration ▪ Robot performance analytics ▪ End-to-end automation ▪ Auto-scaling ▪ Context aware ▪ Advanced workflow analytics ▪ Processing of unstructured data ▪ Predictive and prescriptive analytics ▪ Automation of tasks that involve judgement HIGH LOW
  4. 4. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 4 CURRENT CHALLENGES IN CLAIMS PROCESSING Incremental operational & IT costs Poor service delivery Multiple fraudulent claims Erroneous decision- making Below par integrations Internal threats Evolving customer needs Inconsistent supplier performance Claims Leakage Manual processes Legacy systems Lack of prioritization/ work pressure Inaccuracies & delays Venomous customer intents Bad claim supervisions Improper reporting Wrong forecasting Inefficient data Complex IT structure Changing regulations Multi-focused management Omni-channel experiences New technologies/ concepts Disorganized claim documentation Lack of integration Source: HCL, Pink Elephant
  5. 5. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 5 NEXT-GENERATION CAPABILITIES IN CLAIMS PROCESSING ❑ Labor intensive and time consuming ❑ Manual data processing ❑ Lack of visibility in claims process ✓ Self-service, fast and efficient ✓ Automated data processing ✓ Automatic detection of fraudulent claims OLD METHOD COGNITIVE RPA: NEW METHOD 30-40% decrease in operational costs 50% reduction in claim delays 80-90% data extraction accuracy 70% automation of manual tasks ~100% compliance achievement ~80% improvement in service delivery
  6. 6. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 6 KEY TAKEAWAYS Explore strategies for end-to-end Claims Processing using Cognitive RPA Find out how to automatically extract and process claims information using Intelligent Data Capture solutions Create and manage cognitive agents that can make decisions based on logic and experiential learning
  7. 7. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 7 Role of Cognitive RPA on Claims Processing Insights from UiPath
  8. 8. PROCESS HEATMAP: WHERE TO LOOK FOR OPPORTUNITIES LEVERAGING COGNITIVE AUTOMATION IN INSURANCE INDUSTRY Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 8 © 2005–2019 UiPath. All rights reserved. High ROI Potential Medium ROI Potential Low ROI Potential Attended Robots Option Finance and Accounting IT Product and Service Development HR Legal Procure-to-Pay Common processes across all industries Product and Pricing Risk Portfolio Management Pricing Analysis Competitive Intelligence Program Management Claims Claims Intake (FNOL) Adjustment / Adjudication Claims Payment Processing Fraud Analysis and Prevention Subrogation / Litigation Management Triage and Case Allocation Billing Payment Collection Payment Processing Mortgage Billing Management Agency Billing Management Delinquency Management Reversal Management New Business & Underwriting Application Intake Risk Data Aggregation Policy Certificate / ID Issuance Renewal Underwriting Underwriting Cancellations Telematics Policy Changes / Servicing Service Request Intake Customer Single View & Dashboard Endorsement Processing Cancellations / Withdrawals Risk Monitoring & Alerts / Notifications Marketing Content Management Audience File Management Campaign Management Segmentation and Triaging Marketing Cost Analysis Digital Analytics (Web / SM etc.) Rates Filing and Updates Forms Filing Sales & Distribution Quote Management Lead Management Licensing Management Compensation Management Agent / Broker Management Sales Cost Analysis Correspondence Management Operational Risk Management Solvency Analysis State Regulatory Reports Filing Reconciliation & Statements Fed & State Fin. Stmts. Filing Market Conduct Audit Q / H / Annual Reports Generation
  9. 9. LEGACY CLAIMS PROCESSING CREATES FRICTION AND HIGHER COST OF CLAIMS Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 9 OVERVIEW • Overall satisfaction is 16 points lower among all customers who are using digital FNOL offerings than among those who report via phone • Focus of this use case to make FNOL process seamless to increase Customer adoption and satisfaction For First Notice of Loss submission, typical Legacy process include Laurel A. Customer / Claimant Claims Ops / Adjuster Logs FNOL & gives Claims # asks more details + + Claims Ops / adjuster get the forms Customer Submits Electronic Web Form CHALLENGES • Lack of on-demand availability of claims notice submission • Uncertainty of claims status after submission of FNOL • Lengthy and multi-touch claims process due to repeated requirements Challenges for Insurers • Lower Customer Satisfaction • Higher Claims Operational Cost • Longer Claims Processing Time • Higher Chances of Fraud © 2005–2019 UiPath. All rights reserved.
  10. 10. REIMAGINED CLAIMS INTAKE WITH COGNITIVE AUTOMATION Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 10 © 2005–2019 UiPath. All rights reserved. Robot intakes first notice of loss (FNOL) through web (forms / portal / chat), emails (pdf / scan), classifies and extracts information Robot determines claim eligibility, additional requirements (data, docs, inspection etc.) based on the Claims System Response + AI / ML (E.g. Fraud) Robot pulls and prefills the policy / coverage info, aggregates / validates property & risk info and submits the FNOL to Claims system Robots sends requirements requests to customer, schedules inspection and triages case to relevant Claim Adjuster (based on the assignment rules) Robot creates reserves, checks for re-insurance record and updates the claims info on the re- insurance system. Also creates adjuster view with analytics to aid decision making Unattended Robot Unattended Robot Attended Robot ML Engine* Dynamic Forms Unattended Robot Computer VisionDocument Understanding Human in the Loop * - Optional Computer Vision Chatbot* ML Engine* Unattended Robot Computer Vision ML Engine* Human in the Loop 1 2 3 4 5
  11. 11. THE UIPATH PLATFORM: AN END-TO-END AUTOMATION SUITE Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 11 © 2005–2019 UiPath. All rights reserved. Connect Complex Process Understanding Explorer Expert Explorer Enterprise ProcessGold Connect Enterprise Orchestrator Cloud Platform Management Tools Design Tools Studio StudioX StudioT Robots Attended Robots Unattended Robots Forms Tasks Chatbots RPA and Business Analytics Insights Apps CoE Enablement Native Integrations Build Democratize the design and testing of workflows, from the simple to the complex Manage Securely deploy and manage automations Run Robots work with your applications to carry out automations Plan Scientifically plan your RPA implementation, powered by AI Engage The system of engagement for humans and robots working together Measure Align RPA operations with strategic business outcomes with powerful, embedded analytics Visual Understanding Conversational Understanding Document Understanding Ecosystem Custom Long-Running Workflows AI Skills AI Fabric
  12. 12. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 12 Technology insights How does Cognitive RPA fit into your Claims process?
  13. 13. ▪ Contact Broker/ Insurer ▪ Report the Incident/Loss ▪ Manual/Electronic Claim Entry ▪ Verify and process claim forms and submitted documents ▪ Generate registration number ▪ Send acknowledgement to client Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 13 CLAIMS PROCESSING: PAIN POINTS (1/2) FNOL Validation Check-out Claim Inspection ▪ Membership/Eligibility ▪ Coordination of Benefits (COB) Checks ▪ Diagnosis-Related Group/ Pricing assignment ▪ Get assigned claims ▪ Confirm ▪ Check Out (Pending claims) ▪ Contact Insured/ Client ▪ Fill Forms ▪ Collect proof ▪ Manual intake process ▪ Segmentation of claim (Complex or Simple Claim) ▪ Inadequate resourcing for volume surges ▪ Document classification and indexing ▪ Document/Forms verification workflow ▪ Multiple input sources (Email, Web, Mobile, Paper, etc.) ▪ Disparate Systems ▪ Unstructured data analysis ▪ Correlating multiple documents ▪ Preliminary Fraud detection ▪ Complex workflow ▪ No Live Tracking ▪ Manual reporting with complex questions ▪ Structured and Unstructured data ▪ Image Reading PAIN POINTS
  14. 14. ▪ Provide initial estimate of loss ▪ Send for approvals (if required) Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 14 CLAIMS PROCESSING: PAIN POINTS (2/2) Estimate Adjudication Payment Check-In Claim ▪ Eligibility ▪ DRG ▪ Payment Limit ▪ Denial ▪ Claim Authorization ▪ Audit ▪ Contact Insured (Client) ▪ Negotiate Settlement ▪ Make Settlement ▪ Check In the claim (Completed) ▪ Exclusions and Inclusions verification ▪ Record Management ▪ Research for estimation ▪ Complex approval workflow ▪ Fraud Identification ▪ Data validation for eligibility check ▪ DRG and payment limit ▪ Cryptic feedback for denials ▪ Data extraction for audit ▪ Denial management ▪ Long wait for final settlement ▪ Preferred mode of payment ▪ Transformation of data from various sources ▪ No Live Tracking PAIN POINTS
  15. 15. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 15 CLAIMS PROCESSING: ISSUES CLASSIFICATION ▪ Multiple heterogeneous systems ▪ Legacy systems with no modern endpoints ▪ Collating data from multiple sources ▪ Elasticity ▪ Complex Workflow COGNITIVE DATA CAPTURE, ANALYSIS & STORAGE APPLICATION INTERACTION ▪ Varying document formats due to government regulations ▪ Data extraction from multiple structured and unstructured sources ▪ Eligibility check and exclusion identification ▪ Data Management PROCESS ORCHESTRATION ▪ Multi channel input (web/mobile/email) ▪ No common platform ▪ Communication between teams and clients ▪ Numerous touchpoints ▪ Real-time Progress Tracking ▪ Record Management
  16. 16. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 16 APPROACH TO PROCESS AUTOMATION Process orchestration Application interaction (UI / RPA) Cognitive data captureMonitor input source Extract information Extracted data APP 1 APP 2 RPA interaction Apply business rules Send to downstream system Data Capture Tool
  17. 17. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 17 CLAIMS REIMAGINED Finance System Claims System External System (SaaS System) Legacy System Records System Rules Engine Data Extraction Engine Bot workforce Process Management Framework (Process Orchestration) AI PIPELINE Queue Management Input Source Management Workflow Task Assignments Reports & Analytics Email Mobile Web Chatbot Framework Chat Users Bot workforce for all application integrations (UI/API) and auto scaling for huge volume handling with speed and accuracy AI pipeline for cognitive data capture and claims exclusion with an effective feedback mechanism for continuous learning Process Management Framework for effective workflow management, reporting and analytics Multi-channel interface for anytime anywhere access for claims submission and real-time status updates Chat bot framework that will work with RPA bots to respond to FAQs on claims that saves a lot of time and improves customer satisfaction
  18. 18. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 18 : OUR AUTOMATION FRAMEWORK Infrastructure (On Premise / Cloud / Hybrid) Robotic Process Automation Process Orchestration Data Extraction & Transformation Robotic Operations Center Application Interaction Accelerators Process Solutions Task Assignment Input Source Mgmt Rules Engine Queue Monitoring Workflow Reporting & Analytics OCR & Data Capture Classification Extraction Verification Data Analytics AIPipeline Metrics & Reporting L1, L2 & L3 Support Tool & Infra Update Support Bot MonitoringComputer Vision (AI)
  19. 19. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 19 Case studies Next-generation cognitive RPA capabilities in Claims Processing
  20. 20. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 20 Scenario • Diverse set of Claims documents • Need to extract line items and classify them for inclusions and exclusions to take Claims Decisions • Pre-existing conditions database to be accounted for determining exclusions Benefits ▪ ~66% reduction in claims cycle turnaround processing time ▪ 90% data accuracy (with feedback loop ongoing improvement) ▪ 80% exclusion line-item prediction Claim received through email Clients Robot Claims Management System OCR Extraction 1 Poll mailbox for new emails Mailbox Extract email information and create claim record Create claim record for claim received through app/ portal Extract Information from the documents Claim Classification Claim Processing and Decision (AI Pipeline) Enter Extracted Information and Decision (Approve/ Deny/ Exception) Manual Handling of Exceptions 2 3 5 6 4 7 8 9 Use NLP for tagging claim line items with pre-existing medical conditions Reviewer CLAIMS PROCESSING
  21. 21. CLAIMS PROCESSING – FRAUD DETECTION Steps Automated • Automate Fraud Detection Process at Claims Stage • Identify doubtful claims pattern using analytics against large number of claims • Use scoring technique for fraud possibility Benefits ▪ Categorization of Risk based on claims pattern ▪ Reduction in assessing time by 80% Robot Claims Management System Assign to Claim Adjuster based on Fraud Score Classification of Claims based on rules / fraud repository Network linkage analysis Pattern analysis & Predictive Model AI Pipeline Agency Management System Poll Policy Information Poll New Claim details (Current Loss and Claim History of Claimant ) Poll external records for Claims Data External Sources (NICB, ISO) 3 Trigger AI Pipeline 5 1 Poll PII (Personal Identifiable Information)Social Networks & Public records 4 2 6
  22. 22. FNOL – CHAT BOTS Steps Automated • Analyze Claims reported through various input methods – Email, Chat, Mobile App), structure appropriate response through AI • Create Claims Record in CMS and share repair service information Benefits ▪ 24/7 availability for Claims reporting ▪ Faster resolution of customer queries Robot Claimant Report Loss/Ask for Claims status for Vehicle Accident (Email, Chat, Mobile App) Acknowledge & Send the Claim Reference # Agency Management System Look up for Policy/Client details Transform the data & Create a Claim Record and fetch Claim Reference # Claims Management System OCR Extraction Claim Classification Trigger AI Pipeline to Analyze structured and unstructured data to arrive at appropriate response Database Pull repair service provider details based on the loss information and confirm appointment Send repair service provider details to confirm appointment/Claims Status Update 3 6 4 5 1 2 7
  23. 23. DOCUMENT CLASSIFICATION & INDEXING Steps Automated • Read emails and create requests • Classify and extract information from documents using sophisticated algorithms • Send document to DMS with metadata Benefits ▪ Achieved 70% gain in efficiency ▪ Classification accuracy of 90% and Extraction accuracy of 80% ▪ Extracted information like Policy information used for data analysis Documents received through email Trigger AI Pipeline Get additional information based on policy/ client details Clients/ Carriers Robot 1 2 4 8 6 7 Request DB Claims Management System Poll mailbox for new emails OCR Document Classification (AI) Extraction (AI) Mailbox Update details for document Create request for document 3 5 Update AMS details for document Manual verification and update (process management application) Document Library 9 Save document in DMS with metadata
  24. 24. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 24 We bring Entrepreneurial Agility, Insurance Prodigies ISV Partnerships (Microsoft, UiPath, Abbyy, Google Cloud, AWS) Innovation enablement Unique products & services UX design exploration lab 13 internal IPs by Imaginea Lab 200+ global customers 70 Fortune 500 customers till date 1500+ Engineers, 75+ Architects 3 state-of-the-art offshore facilities
  25. 25. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 25 OUR PROFILE Global Insurance Brokers & Carriers trust us 3 of Top 10 Insurance Brokers 6 Mid-size Carriers 12 InsurTech firms 10 years Partnership / 350+ team with Global Insurance Major $30 mn Investments into IPs and Enterprise Solutions
  26. 26. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 26 SPEAKERS Suresh Babu Chief Revenue Officer, Imaginea suresh.babu@imaginea.com Sathya Sethuraman Global Leader, Intelligent Automation, Insurance, UiPath sathyanarayanan.sethuraman@uipath.com Srivatsan Parthasarathy Principal Architect, Imaginea srivatsan.parthasarathy@imaginea.com
  27. 27. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 27 WEBINAR Next-generation cognitive RPA capabilities in Claims Processing

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