Allocation of cases in claims processing

Our client, a private insurance company, offers the option of submitting the First Notice of Loss (FNOL) by email, telephone or online via the claims portal. The incoming claims were collected centrally and manually forwarded to the different teams for processing. This was inefficient and led to longer processing times in case of incorrect allocation or overloaded teams.

Implementation

On the basis of a cleansed data, ZENAI Adaptive Claim was trained using a supervised learning algorithm. It now recognises the different types of claims and independently forwards the message to the responsible department. A feedback loop enables employees to provide feedback on whether the claim was forwarded correctly. This feedback flows directly into the calibration of the algorithm. In addition, the implemented solution also captures the specialisation of the claims officers and their availability, which enables optimal case allocation and employee utilisation.

Result

With ZENAI Adaptive Claim, the assignment of claims is fully automated. The distribution of the messages to the individual employees is done based on the current workload and is therefore more precise and substantially faster than in the manual process. In the process, the system learns with every claim and thus improves continuously. The system learns with every claim and thus improves continuously.