Swiss Re Reinsurance Solutions - Claims Automated Rules Engine – Insurer Innovation Award 2023

1. 1
Claims
Automated
Rules Engine
Evolving customer experience with speedy claims
assessment and decisions
Reinsurance Solutions

2. WHAT IT IS:
A powerful engine to streamline the claims process by triaging submissions,
automating tasks and decisions, and providing next action recommendations –
ultimately enabling claims experts to spend more time where they make the
most difference
WHAT MAKES IT GREAT:
▪ Assists claims experts in making claims decisions by assessing the nature of
the claim and quality of claims evidence against a set of customizable risk-
based rules.
▪ Provides access to Swiss Re’s extensive, global claims knowledge in an
automated and scalable way
▪ A cloud-based software-as-a-service solution for quick implementation,
and users benefit from continued enhancements
IMPACT TO AN INSURER’S BUSINESS:
Claims Automated
Rules Engine
2
Improved consistency,
accuracy and
confidence in claims
outcomes
Efficiency gains –
adjudicators have
more time to focus
on areas where they
make the most
difference
Faster claims
response times –
deliver decisions in
minutes, not months
Claims experts work in an emotionally demanding
area, often with significant administrative burdens
and tight turnaround demands. CARE frees up
claims experts to focus on claims that need the
most attention.

3. 3
Health or
Life Claim
Claimant
A significant, emotional
event. At their most
vulnerable
Claims Team
Stressful, upsetting,
emotionally draining –
nature & volume of claims
The process can be challenging
for all involved
Automation can improve the experience
for everyone & brings additional benefits

4. Why would an insurer
choose Swiss Re’s
Claims Automated
Rules Engine solution?
Our experience & reach
Rules designed
by our claims experts alongside
our clients
Developed for insurer all over the
world
Can be used standalone or as
part of our full digital value
chain
01
One of world’s largest
reinsurer — unrivalled
insight & expertise
03
The global benchmark
for applied risk knowledge
02
A reputation for innovation
& automation excellence
04
For use by any business,
anywhere — flexible,
digital solutions using
cloud technology, API
Our solutions reflect Swiss Re’s 150+ years’
experience & world-leading reputation

5. The standards of customer service that people now expect,
are set by forward-thinking companies outside the insurance
world. We must evolve.
5
Automation of easy tasks frees up claims handlers
to spend more time with customers when they
need support most
A personal, empathetic touch
Claims decisions in weeks not months. Ensure
claims are assessed & managed by the right claims
experts at the right time
A seamless, streamlined process
Trust generates loyalty &
brand advocacy
Transparency & confidence
We help insurers offer their customers:
“
Our
Claims Automated
Rules Engine helps
improve the
claims experience

6. 6
Our
Claims Automated
Rules Engine
helps insurers to boost
their business
Automation through our solution means:
01
Efficiency
Spend less time on easy tasks
& focus resource where it’s
most needed
Erase those pain points
& inefficiencies!
The time it takes to create
timelines & claim summaries
The effort in ensuring that the
right benefit entitlements are
being applied
Endless scrolling through
documents to find specific
information
Having to have multiple screens
& documents open
Spending time on admin rather
than assessment & case
management
02
Profitability
Through efficiency, customer
loyalty & advocacy
03
Confidence in your decisions
Through robust automated rules &
renowned Swiss Re insight & support
04
Future proofing
Digital transformation & credibility

7. 7
How does Claims
Automated Rules Engine work?
01
Swiss Re claims experts
design rules alongside
our clients to classify &
identify claims by their
risk level & complexity
02
Rules integrate with
client’s processes &
systems & pre-populate
a questionnaire
03
Questionnaire prompts
claims expert to
complete more
sophisticated risk profile
questions to generate a
risk score — ensures
questions are relevant &
necessary to the
circumstance & claim
type
04
Decision outcome or
recommend actions
provided, depending on
client preferences
05
Swiss Re offers decision
support for more
complex cases, where
needed

8. 8
How does Claims
Automated Rules Engine work?

9. 9
How does Claims
Automated Rules Engine work?
Co-creation of claims
risk profiling rules
Co-create tools to complement our Clients’
operating models, risk management practices
and risk appetites ensuring the right claims are
being assessed and managed by the right
claims expert at the right time
Rules are designed by Swiss Re
Claims Experts along side our Clients to identify
and classify claims by their risk level
and complexity
Connect Client claims management systems to a
web based dynamic and reflexive questionnaire
and rules engine where available claim data is pre-
populated. The questionnaire will prompt the
claims expert to complete the more sophisticated
risk profile questions to generate a risk score,
decision outcome or recommendation depending
on Client preference
Expert driven
proposition
Integration with your
process and system

10. 10
Claims
Automated
Rules Engine
in action
Swiss Re partnered with
its largest client in China to:
Speed up claims
assessments & decisions
Maintain consistency
& accuracy
Ensure claims were allocated
to claims experts with the
right experience
Process:
Co-created critical illness
rules for risk scoring
Developed sophisticated rules
for 10 critical illness conditions
accounting for
of client’s critical illness portfolio
90%

11. 11
Benefits
of our Claims
Automated
Rules Engine
Get up and running in
just a few months —
light touch integration
Simple to use while
maintaining quality of
decision making
Ready access to rules-based
updates, developed in
partnership with you
24/7 self service support
infrastructure backed by
Swiss Re globally
Cheaper than traditional
claims solutions —
‘software as a service’
Use standalone, or
integrated with our other
suite of claims solutions

12. In Summary
What Swiss Re’s
Claims Automated
Rules Engine
offers insurers
• Automation to improve the life
and health claims experience for
customers and claims handlers
• The best of Swiss Re —
combines our reputation for
innovation and automation
excellence with our unrivalled
risk insight and expertise
• Digital credibility — future
proofing, API, cloud technology
• Increased profitability —
through efficiency, customer
loyalty and advocacy
• A custom-fit, scalable and
affordable solution
• A solution that can standalone or
as part of a Swiss Re digital value
chain ecosystem
• Easy implementation whether
the insurer has an existing system
or are new to automation
• Swiss Re support every step of
the way — design,
implementation, day-to-day
trouble-shooting and
claims support
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