Speaking at the Databricks Data+AI Summit in San Francisco, AI practice executive Kranthi Nekkalapu said that implementing AI into claims processing was an area that the whole industry wanted to move forward in.
“Where we are right now is we are working through automating our claims processes using agents. Now, this is where everybody naturally wants to progress,” Nekkalapu said.
“Claims processes are inherently very complex, but at a high level, they are workflows.
“There are some set stages. You have an intake to start with. We triage or we assess the claim, and then we fulfill, taking lots of actions, and … ultimately settle [the claim].
“[With agentic AI] the workflow remains the same, but within that, there could be several tasks. These tasks themselves could be done by agents.”
While having the full process managed by AI is still a “work-in-progress” according to Nekkalapu, certain sup-processes are due to come into production this month.
“We haven't automated the full end-to-end process, but there are sub-processes within that which we are automating at the moment,” he said.
“The first set of ones, about five of them, are expected to go into production later this month.”
Two of those agents are set to work in the first stage of claim initiation, also known as the first notice of loss (FNOL). Here, the AI will analyse and validate reports before classifying them and moving them through internal processes.
“We have got voice agents which went into production very recently,” Nekkalapu said.
“They do the initial intake of the claim in some cases, and if it becomes more complex, then pass on to humans.
“There are multiple channels in which we intake claims.”
Following this, a “coverage check” is performed by a “system of agents.”
Importantly, humans remain a key part of the claims process, particularly in scenarios where claims become too complex for the AI.
“We do want a human gate there, where all the rejected claims may have to go through a mandatory human review,” Nekkalapu said.
In the future, Suncorp wants to implement “complex agents” that can determine if a claim should be covered.
“There could be a claim where there was a storm last night and a tree fell on the retaining wall, damaging a pipe that's running next to the wall, so that water seeped into a garage and damaged all the carpets and rugs in the garage,” he said.
“That is a contents insurance claim. But if you are looking at coverage, you need to identify what the loss cause is for that event, and based on that, you determine coverage.
“It could be the storm, it could be water leakage, or it could be the impact of the tree falling. It's not an easy problem.
“Our claims handlers spend a lot of time [on this], and it could be complex.
“We've developed a workflow with agents in there which can do all these jobs with 99 percent accuracy.”
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