AIA - Insurer Innovation Award 2022

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AIA confidential and proprietary information. Not for distribution.
APRIL 2022
AIA KOREA & GROUP DATA ANALYTICS
KOREA
CLAIMS EXPERIENCE
INNOVATION
VIA ADVANCED CLAIMS MANAGEMENT
1

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To become the most customer-centric insurer…
o Hospitals & health clinics only issue hard copied
medical certificates to patients
o Electronic Data Interchange (EDI) is not available
o Customers must decipher medical terminologies and fill
in lengthy claims form
o Claims assessors must validate customer input fields
against the submitted scanned / photographed documents.
 Enable Optical Character Recognition (OCR) solution in
MYAIA
 Enhance MYAIA UX for easy and intuitive claims
submission via pictures
 Implement AI Machine Learning model based on OCR
captured data
 Minimize claims leakage by leveraging AI risk
indicators
 Strongly drive customers towards using digital platform
Implemented
Solution
Existing
Challenge
o Heavy manual human
effort
o Negative impacts on
Straight Through
Processing (STP)
rate and Turnaround
Time (TAT) to pay
customers
o enabling customer
to submit claim
through app
o Capture required
data automatically
o Uplift STP and
improve TAT
o Minimize claims
leakage and human
effort
o Best in class
experience
Claims Experience in Korea Impact
Re-imagining Claims Experience in Korea

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New AI-enabled claims process have significant improvement in Customer Experience by
improving TAT whilst minimizing human required inputs
^Automatically assigned to skilled human assessors (based on individual
capabilities) if AI decides not to pay
Enhanced Customer Experience with AI-
enabled Claims Process
*for cases that OCR successfully completed, Auto Rule and AI approved to pay
Front-end: Customer Claims
Submission
Back-end:Claims Assessment
Total Process
Time
Existing Claims Process
2 Days +
• Fill paper-based claim forms
• Collect & copy supporting documents
• Submit claims form in person or by
mail
• Manual data entry by operator
• Document Verification
• Benefits screening
• Manual Claim Assessment & Investigation
• Cheque payment
AI-enabled claims process
Goes to MYAIA
Scans Documents Submits
Claims
AI
Automation
Platform^
AI decides
to pay
Claims
Paid
Less than
25 mins*
New

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AI Automation Platform
Document
Intelligence
ML Decision
Engine
Risk Detection
System
01 02 03
ML model learns
from historical data
to predict claim
payment decision
OCR extracts
required data from
the photos of
document
Advanced
statistical
analytics used
to identify outlier
behaviors and Fraud
Waste and Abuse

5. AIA confidential and proprietary information. Not for distribution. 5
MYAIA
Customer submits claims in
MYAIA via taking picture of
required docs. and
minimum required data
Document
Intelligence
Process
OCR Engine
extracts required data
from the photos of
document
01 – Document Intelligence
MYAIA OCR Solution
AccuracyItem Accuracy
Name 81%
Resident Number 91%
Hospital Name 87%
Hospital Address 87%
Doctor Name 90%
License Number 90%
Admission/Discharge Date 81%
Disease code 83%
Surgery Name 76%
Surgery Code 80%
Surgery Date 80%
OCR Extraction –
medical report

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02 - ML Decision Engine Performance
What did AI do?
What is achieved?
AI learns from historical claims assessment to decide acceptance of new
claims based on ML risk threshold.
AI increases operational efficiencies and enhanced customer experience
by shortening processing time and reducing errors.
0% 100%
92%
STP Claim Automation
For every 1000 claims, 920
claims are automated
0% 100%
99.7%
Precision
917 correctly paid out
0% 100%
0.3%
Financial Leakage
For every $10,000 paid, $30
should not have been paid

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03 - Risk Detection System
What did AI do?
What is achieved?
AI forms a Risk Detection Engine that systematically scans historical data
to detect potential fraud, waste and abuse claims.
20+ risk indicators deployed in production to monitor risk level of claims
with high-risk claims flagged as outliers for manual adjudication.
Excessive
length of stay
High Claim
Amount
Surgical Procedure
Relevance
Gender Diagnosis
Relevance
Gender Procedure
Relevance
?
Risk Indicators Examples

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AI Benefits
Turbocharging claims payment while mitigating FWA risks
The implementation of Advanced Claims
Management in Korea:
Customers show very positive
feedbacks on the implementation:
B
C “Super speedy from submission to
payment. I’ve never experienced
such insurer – thank you!”
“Just simply take picture of
medical certificate and attach,
then that’s it. Too simple & I
like it!”
“From claims submission to payment,
this seems like a whole new world!
... marvelous system.”
K
H
“... very surprised at how AIA paid my
claims so quickly. I acknowledge AIA is
the best out of all insurers in terms
of system enhancement. I am proud to be
AIA’s customer.”
Automate claims adjudication for 94%
of in-scope A&H claims
Represent around 70% of all types of
claims submitted locally
Maintain at most 0.4% claims leakage
Streamline process for customers to
receive a faster decision and payment
Improve overall customer experience
while mitigating FWA risks