Making a claim on health insurance can be stressful for customers, who may be in distress from an illness or an unexpected accident and desperate for a quick response. However, most insurers have not embraced the technology innovations that could help them meet customer expectations while also identifying ineligible or fraudulent claims.

In this use case, we partnered with XpertRule, a vendor of an intelligent decisioning platform, to design an interactive, end-to-end automated claim processing flow to tackle this challenge. Our approach applies an intelligent decision-making process that embeds data analytics and machine learning algorithms to create a decision tree that is fully explainable, and that mirrors the logic a human agent would follow. In health insurance, we argue, the drive towards instant claims authorization has the potential to cut costs at the same time as improving customer satisfaction and the customer’s quality of life during a stressful period.

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