Automated Claims Processing

Automate claims in real time for instant processing

Deployed in

One of the leading general (non-life) insurers in India. They have gross underwritten premiums of ₹136 billion in FY20 across general insurance products.

Key Insights

The objective of this engagement was to explore Automated Claims Processing (ACP) - to streamline the claims process, standardize decisioning and deliver a superior customer experience, as claim processing was one of the key triggers for successful renewals.

  • Claims processing was heavily manual created bottlenecks during load spikes . Current process fell short of standardized decisioning, due to the differences in judgement between experienced and new claims assessors. Company's average processing time for cashless claims was around 2 hours, considering the multiple handoffs between systems and people. High turnaround times harmed the customer experience while inefficient processes also offered opportunity for cost reductions.

  • The company onboarded as an claims automation partner to deploy ACP to automate complete claims adjudication tasks, work as an intelligent claims assessor, maintain consistency in decision quality, all at a fraction of manual claims cost and time while reducing claims leakage. ACP module was trained on 3 years historical data to jump start the learnings.’s team normalized decisions and confidence scores towards automation and augmentation decisions ranges. Today, in certain cases, customers' received admissibility decisions in near real time.

  • team had started off with automation of about 30% in production in 2018, which has now scaled to 63% automation. All retail and group claims from cashless are processed through ACP. The module automates yearly claims of around 110K+ from cashless channels.

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