AI in Insurance

AI In Insurance

Insurance is driven by data. The data has a huge effect on the company’s bottom line and the satisfaction of the customer. A recent study found that nearly 80% of insurance executives believe artificial intelligence will revolutionize the way insurers gain information from their customers, with more than half saying the biggest benefit is being able to leverage better data for improved insights into the customers.

Ready-to-deploy AI in Insurance

pa

Insurance Prior Authorization Priodiction

chatbot

AI-Powered Chatbot

ire

Insurance Recommendation Engine

cp

AI in Insurance Process Automation

  • AI in insurance product development
  • AI in underwriting
  • AI in claim processing
  • AI in account management
  • AI in policy renewal
  • AI in marketing and customer acquisition

 

AI in Insurance Fraud Detection

Service Provider Frauds

  • Billing services that are not actually performed
  • Unbundling, i.e., billing each stage of a procedure as if it were a separate treatment
  • Up-coding, i.e., billing more costly services than the one actually performed
  • Perform medically unnecessary services solely for the purpose of generating insurance payments
  • Misrepresenting non-covered treatments as medically necessary covered treatments for the purpose of obtaining insurance payments
  • Falsifying patients’ diagnosis and/or treatment histories to justify tests, surgeries, or other procedures that are not medically necessary
Screen Shot 2018-08-07 at 5.41.51 PM

Subscriber Fraud

  • Falsifying records of employment/eligibility for obtaining a lower premium rate
  • Filing claims for medical services which are not actually received
  • Using other persons’ coverage or insurance card to illegally claim the insurance benefits

Insurance Carrier Fraud

  • Falsifying reimbursements
  • Falsifying benefit/service statements

Conspiracy Fraud

The fraud involving more than one party, i.e., a patient colludes with his physician,  fabricating medical service and transition records to deceive the insurance company to whom he subscribes

Next Steps...

Contact us for a live demo to learn more about our ready-to-use AI for Insurance.