AI Powered Claims Adjuster Bot™
End-to-end claims automation cannot be achieved with traditional programming techniques and requires AI powered software robots that can that recognise dynamic interfaces, read complex documents and make important decisions
Automation Of Simple Claims Is A Very Difficult Problem To Solve
The challenge for straight through processing is
automating policy coverage analysis which is the
foundation of any claim assessment. This is a complex
task that historically has required a desk adjuster to
analyse complex paper based policy forms at claim time.
Redesigning How Insurance Claims Are Processed Is Our Top Priority!
The claims process represents the most acute pain, it is where animosity toward the industry is most commonly cultivated. Re- imaging claims by removing all of the friction, hassle, cost, and delays, is a key driver of our leadership in claim automation.
How The Claim Adjuster Bot Works
Broker or Customer submits claim form via email
Bot opens email and retrieves the claim form
Bot extracts relevant data from claim form
Bot retrieves policy data from policy management system
Bot uses decision engine to validate terms & conditions
Bot performs weather check ( weather claims only)
Bot performs Sanction check
Bot perfroms ISO claim check
Bot identifies the proximate cause
Bot makes coverage determination
Bot generates client correspondence
Claim Adjuster Bot Key Features
Has already distilled hundreds of thousands of hours of claim adjusters work experience and consistently adjusts to standard each time regardless of the complexity of the claim
Is trained on tens of thousands of historical claims as well as human adjuster decisions and the algorithms learn from experience by analysing a large variety of different claim
Uses a combination of AI technologies and understands claims like a human adjuster
and is able to process claims in real time with unmatched consistency. Harnesses AI at the beginning of the claims process, creating efficiencies for the insurer and greater clarity for the policy holder
Has surpassed human accuracy and is trained to perform many complex claim adjusting tasks faster, cheaper, more accurately and more consistently than humans
Thinks and acts like an experienced insurance professional.
The Claims adjuster Bot can identify proximate cause and perform policy coverage analysis. This is a complex task that to date has required an experienced claims adjuster to analyse the physical policy documents and determine if there is coverage for the loss.
Insurer Value Proposition
Reduction in elapsed time for making a coverage determination from 2 or more days to 5 minutes for 80% of claims
50% reduction in loss adjuster expenses by automating the multiple steps and hand-off’s required to finalise a claim
5 x increase in claims processing productivity by increasing the number of claims handled per desk adjuster each day
Focus skilled labour on desk adjusting and reduce the amount of unnecessary investigations and property inspections
Accelerate the speed of response, improving customer service and peace of mind for policy holders.
Make A Coverage Determination On 80% Of Claims Within 5 minutes Of Receiving The Claim
Talk to a Tautona expert