This solution expedites and streamlines insurance claims payout processes through leveraging artificial intelligence, which in turn reduces human errors and administrative costs.

1. Contact us
Varun Mittal
EY Global Emerging Markets
FinTech lead
varun.mittal@sg.ey.com
FinTech Hub
www.ey.com/sg/FinTechHub
Case study
Context:
A general insurer wanted to reduce health
claims processing time and cost by
automating the claim decisioning process
which had dependency on doctors and experts
who are high cost resources. In addition,
delays in health claim processing led to poor
customer experiences.
Recommended configuration:
• Implement an AI platform that uses
information from historical data along with
the inputs of industry experts
• Once implemented, claims will be filtered
through the AI platform, where the
majority of claims decisions will be made
• While testing the AI platform, 95% of test
cases were processed within minutes
without any manual intervention needed
• If prompted by AI interface, an industry
expert will examine the claim if needed, but
the AI interface will handle the majority of
cases
Boosting insurance claims pay-out
efficiency
Development of AI platform
Pain points faced by consumer
Time consuming
claims processing
Key benefits of AI platform
1
Human errors due
to complexity in
decision making
Ineffective fraud
monitoring and
detection
High cost of experts
for decision making
AI platform
Expert
inputsHistoric data
AI platform trained using historic data and expert inputs
InsurerClaim
Increased STP with only a few cases passed to doctors and experts
AI platform
Expert
Inputs
Increased STP percentage
Enhanced and self learning
fraud monitoring
Reduced claim
leakage
Reduced claim processing
turn around time (TAT)
Client impact:
• Claims processing time is reduced from 3
days to a few minutes
• Number of cases handled by experts was
reduced, resulting in savings
• Automated claim processing results in
reduced human errors resulting in reduced
claims leakage