Optimizing Claim Analysis: Addressing Oversight with AI Business Solutions for Enhanced Client Satisfaction

When a disability or accident claims analyst fails to notice a crucial line in the medical record, they may erroneously conclude that there was misrepresentation during underwriting, resulting in a wrongful denial of claim. This seemingly minor oversight can cause significant ramifications.

The insured will likely appeal the decision, clarifying the information that the claim analyst overlooked. Now the insurance company will pay the claim, but the initial rejection may cause the insured to feel considerable dissatisfaction. As a result, they may file a complaint with their state insurance department or spread negative word-of-mouth about the company.

This minor, but meaningful, human error reminds me of a great blog by Sam Friedman, an insurance research leader at Deloitte, about Claims satisfaction:

“...In such cases, even if they (insurers) eventually pay up, any delays or unnecessary hassle may still leave policyholders with a bad taste in their mouths. This could undermine retention and may prompt complaints that go viral over social media. There even might be regulatory implications.”

This example highlights the importance of finding a claims analyst solution that surfaces critical information among thousands of pages of medical records to reduce human error and improve client satisfaction.

With DigitalOwl’s advanced AI-platform, claim analysts can expose a complete view of all treatment and injuries within medical records, highlighting critical details in hundreds or thousands of pages, and use in-depth filtering to efficiently search by body part to only see the information that’s relevant to the claim. What’s more, they can even Chat with the medical record to ask nuanced medical questions for answers found in single-mentions throughout hundreds or thousands of pages of medical records to efficiently make more informed decisions.

These solutions streamline processes, optimize the allocation of resources, and enhance time-to-payout, thereby bolstering customer satisfaction. With a consistent accuracy rate exceeding 97%, our AI solutions also offer click-to-evidence functionality for transparent and straightforward result validation claims analysts can trust.

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Don’t let a simple oversight define your customers’ experience. Contact DigitalOwl today to learn more about our cutting-edge solutions.

Claims satisfaction: The most challenging insurance metric? A blog post by Sam Friedman, insurance research leader, Deloitte Services LP, September 19, 2018

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