Insurers to use AI automation due to Pandemic

  • Diagnosis and claims settlement can be done in minutes now
  • The companies have developed a risk appetite model to diagnose or consult a medical officer
  • Star health, ICICI Lombard, Edelweiss and Aegon are adopting to the new way of medical insurance

Star Health and ICICI Lombard have deployed AI-ML solutions to make the cashless claims pre-authorisation process for health policy holders instant. The entire process that used to take hours earlier is being done in minutes now. Insurance companies have been toying with AI-ML solutions for the past couple of years. But the surge in new customers, greater demand of claim settlement, renewal and grievance redressal following Covid-19 have provided insurers an opportunity to test and validate many of these solutions on a larger base.

“All the data, including the doctor diagnosis, the prescribed treatment procedure, is taken by the AI system and is matched with the policy terms to deduce if the claim is admissible. And if it is admissible, what is the amount to be authorized. All this is done in minutes,” says Girish Nayak, chief of service, operations and technology at ICICI Lombard.

Companies shifting to AI/ML platforms

Edelweiss General Insurance says its remote survey app, BOLT, for motor insurance claims has seen a rise in adoption in the last four to five months. “We are now seeing around 60% of remote claims being handled virtually through the BOLT app. This self-survey has also brought in convenience of spot settlement,” the insurer’s spokesperson says.

Aegon Life Insurance recently added a Video Policy Doc feature on its app, offering customers a personalized video that carries important information about the policy they just purchased. This is not only addressed customer concerns of not receiving physical policy documents during the lockdown but also saved them the effort of giving through a lengthy PDF to review critical information. “We use AI/ML solutions to create videos on-the-fly, by embedding customer-specific policy information and generating the video link automatically, instead of producing each video separately,’ says COO Naveen Bachwani.

Risk appetite model

The insurer has built a risk appetite model. When you want to buy a policy, you have to declare existing health conditions. If these conditions are recognized by the model, a health policy is automatically approved. In case you declare diseases that the model does not recognize, a tele-medical consultation follows.

“In the last three to four months, many of our customers were onboard with the help of this AI-ML solution. Over 20% of our policies were underwritten by machine,” says managing director Anand Roy.