Cloud AI Claim Processing System for Insurance Automation
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Solution Overview
Problem
Conventional insurance claims processing is labor-intensive, time-consuming, and costly, requiring large numbers of human claim adjusters, leading to delays, frustration for insured persons, and limited flexibility in communication methods, with many systems not being available 24/7.
Innovation Solution
Implementing a cloud computing-based system using artificial intelligence (AI) to automate claim processing, enabling electronic communication through chat, email, and IVR, reducing dependence on call centers, and allowing 24/7 access, with AI claim handlers that can process claims from start to finish, escalate issues, and provide personalized updates.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Ease of operation
If manual claim processing by human adjusters is used, then personalized customer service and complex claim handling are improved, but labor intensity, processing time, and costs increase significantly
Solution Approach 1:
The system segments claim processing into different types: routine claims are handled automatically by AI claim handlers, while complex claims are escalated to human adjusters. This segmentation allows AI to handle high-volume simple claims efficiently while human expertise is reserved for complicated cases, resolving the contradiction between automation efficiency and service quality.
Solution Approach 2:
The patent introduces an intermediary escalation mechanism where AI claim handlers automatically transfer complex or uncertain claims to human adjusters. This intermediary layer ensures that routine claims are processed efficiently by AI while maintaining the option for human intervention when needed, thus balancing productivity and service quality.
2Reliability
If human claim adjusters process all claims, then complex and sensitive claims receive appropriate attention, but processing delays and customer frustration increase due to limited availability
Solution Approach 1:
The system implements self-service through AI claim handlers that automatically process routine claims without human intervention. These AI handlers are available 24/7 to handle claims immediately upon submission, eliminating waiting times associated with human adjuster availability while maintaining reliable processing for routine cases.
Solution Approach 2:
The patent applies preliminary action by having AI claim handlers immediately assess and process claims upon receipt, performing initial triage and handling before human adjusters are needed. This preliminary automated processing eliminates delays while ensuring human expertise is available when actually required for complex cases.
3Ease of operation
If traditional call center systems are used, then real-time customer interaction is improved, but system flexibility and scalability are limited
Solution Approach 1:
The patent implements multi-functionality by creating a unified cloud-based platform that handles multiple communication channels (phone, email, chat, mobile app) through a single AI system. This universal platform can adapt to different claim types, communication methods, and scaling requirements, resolving the contradiction between interaction capability and system flexibility.
Solution Approach 2:
The system applies dynamics by making the claim handling capability dynamically scalable through cloud infrastructure. The AI claim handlers can automatically scale up or down based on claim volume, and the system can dynamically route different types of claims to appropriate handlers, providing both real-time interaction and high adaptability.
4Productivity
If cloud-based AI systems are implemented, then processing speed and scalability are improved, but initial system complexity and implementation costs increase
Solution Approach 1:
The patent applies copying by using pre-trained AI models and templates that can be replicated across multiple claim handlers and scaled through the cloud infrastructure. Instead of building complex systems from scratch, the solution leverages copied, proven AI architectures that can be rapidly deployed and scaled, reducing implementation complexity while maintaining high processing speeds.
Data Source
AI summary
Example methods, apparatus and articles of manufacture to process insurance claims using cloud computing are disclosed herein. An example system to process an insurance claim using cloud computing includes an assistance resource of a cloud computing platform configured to interact electronically with at least one of an insured person, a representative of the insured person, or a representative of an insured entity to obtain information related to an insurance claim, an artificial intelligence resource of the cloud computing platform configured to process the information to identify an action to be taken for the insurance claim, and a backend system configured to perform the action, the backend processing module also useable by a person to manually process the insurance claim.