BUSINESS ISSSUE

 

The client is one of the leading international financial services groups in the world for more than 100 years, to help people make decisions easier and live better. Having many offices located in Canada, the US, Asia, and Europe, the client has been providing financial advice, insurance, and wealth and asset management solutions for any individuals or organizations.

 

Claims processing is probably the most important function for any insurance company. However, that process often comes with a lot of paperwork, particularly when it comes to claims. As a result, it needs a lot of time for the whole procedure which is between two and four weeks between putting in a claim and receiving payment. That’s why the client needed an automation solution for claim process to improve customers’ experience and increase their satisfaction.

STRATEGY & SOLUTIONS

  The client needs to have a full automation claim process as soon as possible. Not only decrease the time, most importantly, all the information must be kept confidential the best for policyholders.
 We use our advanced OCR engine to extract all the data from the customer’s hospital checkout.
∨  Next, based on the data we already have, we use machine learning to understand the diagnosis and to extract ICD-code following global rules.
 All the data extracted from the beginning will be automatically cross-checked with the customer’s personal documents on different platforms by AutoQC. It can recognize any fraud or error intention easily based on document quality analysis scoring, business rules scoring and data pattern scoring. Thereafter, it is able to make the process ‘strikethrough’ to the client without any human touch.
∨  If the data is 100% matched, we transfer them to the client. Otherwise, we notify the client to directly check on unmatched data. 
∨  In the end, the client will make a decision how acceptable the claim is.

 

 

BUSINESS OUTCOMES

Nearly 95% the policyholders feedback positively on this new e-claim
The client isn’t ‘flooded’ with tons of paper and has more space.
It is way easy to identify fraudulent claims to have better decisions.
It helps the client to reduce cost for traditional data processing

 

.

CLIENT’S FEEDBACK

DIGI-TEXX has consistently developed with us on the digital transformation journey. We focus on being ready and able to fulfil customers’ needs from a claims perspective. That’s what we ask of our vendors and our partners, and DIGI-TEXX has delivered.