Can AI Solve Health Insurance Fraud?

RAFAEL LOURENCO | February 18, 2020

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Insurance fraud scams seem to make the news at least every month, as organized criminals seek to exploit the way insurers reimburse clinics, pharmacies and other providers for their services. What’s often shocking is how much money fraudsters can steal from insurers before they’re caught. Recently, in a single month, two separate alleged fraud rings based in California were busted for scams that investigators say netted $20 million or more.

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Allstate- Richards Group

The Richards Group is a full-service insurance agency offering Wisconsin residents affordable, comprehensive personal coverage, including homeowners insurance; auto insurance; life insurance; motorcycle insurance; boat insurance; personal liability insurance and renter’s insurance.

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Will your insurance IT investments pay off?

Article | April 12, 2021

Automated claims processing, price comparison platforms, mobile bill paying—these are just some of the digital services that insurance customers expect and insurers want to provide. As the demand for digital skyrockets, so does the need for insurers to invest in IT. In the past seven years, the share of IT in total operating costs of property-and-casualty (P&C) insurers increased 22 percent. The rise of digital means technology is no longer a cost center. Rather, it is an asset that, if managed well, can increase growth and profitability. But do these IT investments pay off? As the COVID-19 pandemic exacerbates already increasing cost pressures, insurers’ IT budgets are under scrutiny; they want to see the business impact of their IT investments. Insurers with targeted IT investments achieve better growth and performance Data from McKinsey’s Insurance 360° benchmarking survey provide strong evidence of the positive business impact of targeted IT investments. In fact, insurers that invest more in technology outpace competitors that don’t pursue targeted investments in business measures such as gross written premium (GWP) growth, return to shareholders, and expense and loss ratio (exhibit). As an example, in life insurance, companies that invested more in IT saw a greater reduction in expense ratios (by 2.0 percentage points) and higher returns on technical reserves2 (1.7 percentage points) when compared with insurers with lower IT investments. Insurers achieved these outcomes within three to five years of making their investments. For P&C insurers, those with high IT investments achieved approximately twice the top-line GWP growth of low IT investors. High IT investments also produced a greater reduction in combined ratios when compared with those with low IT investment. Four areas for targeted IT investment So what kinds of technology investments can help insurers achieve growth and improve productivity and performance? Investments in four areas are critical: Marketing and sales: Marketing technology solutions can increase sales and processing efficiency, improve the quality of core customer-facing processes such as policy inquiries and policy applications, and improve customers’ overall experiences. McKinsey’s Insurance 360° benchmarking data show that tech investments in this category can facilitate top-line growth for P&C insurers by up to 20–40 percent; for life insurers, that growth could be 10–25 percent over a three- to five-year period. Underwriting and pricing: Automated underwriting fraud detection can improve the likelihood that insurers correctly identify fraud and set accurate prices. A pricing tool kit that analyzes pricing across competitors and enables a flexible, more segmented market versus technical pricing further improves profit margins. Insurers that deploy these and other product, pricing, and underwriting technologies have seen improvements in their profit margins by 10–15 percent in P&C insurance and 3–5 percent in life insurance. Policy servicing: Workflow automation, artificial intelligence–based decision support, and user experience technologies in policy servicing and within IT can improve the customer self-service experience and automate back-office processes, thus reducing IT and operations expenses. And state-of-the-art self-servicing options will reduce processing times and even improve customer experience. An analysis of programs for large-scale insurance IT modernization finds that insurers that deploy these and other product, pricing, and underwriting technologies have seen improvements in their profit margins by 5–10 percent in P&C insurance and 10–15 percent in life insurance. Claims: P&C insurers can use automated case processing—machine-learning technology trained to process basic claims cases—to segment more complex cases and significantly improve claims accuracy. Combined with better partner integration and steering technologies embedded in a transformation of the claims operating model, such technologies can help P&C insurers improve profit margins by 25–40 percent, according to McKinsey analysis of large-scale IT modernization programs. To realize the full value of IT investments, insurers must strategically allocate their resources and view tech as an asset, not a tool.

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IoT Combined With AI? A Revolution

Article | February 17, 2020

Data is the foundation of insurance, and two emerging technologies, the Internet of Things (IoT, and artificial intelligence (AI), are making that foundation more useful than ever. IoT allows internet-connected devices to send and receive real-time data. Insurers are increasingly using IoT data to streamline operations, improve customer engagement, offer discounts for and encourage healthy behavior such as safe driving and regular exercise, calculate risks more accurately, boost competitive advantage and streamline compliance.

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How Are Chatbots and Artificial Intelligence Are Adding Value To The Insurance Sector

Article | April 7, 2020

Chatbots are capable of providing one-on-one consultancy to website visitors, customers, as well as internal employees. In the insurance industry, this is vital, as it is a large, complex industry that customers and employees alike may have questions about. Where do chatbots fit in within the insurance industry? One of our chatbot experts has crafted a list of key areas for chatbots in the insurance industry.

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How AI will improve CX in insurance

Article | March 10, 2020

How many times have you called customer service expecting a quick answer, but were instead passed around to a number of different people who didn’t have your full story, forcing you to repeat yourself unnecessarily? And how many times did this lead to a much longer-than-expected resolution? We’ve all experienced this at least once and as a result, we understand the importance of streamlining experiences to keep customers happy. It begs the question: How can you deliver an experience that doesn’t leave customers running for the hills?

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Spotlight

Allstate- Richards Group

The Richards Group is a full-service insurance agency offering Wisconsin residents affordable, comprehensive personal coverage, including homeowners insurance; auto insurance; life insurance; motorcycle insurance; boat insurance; personal liability insurance and renter’s insurance.

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