Intelligent automation for the insurance industry

Meet Theresa, CIO of an insurance company inundated by legacy systems. See how she uses cloud-native technologies to modernize operations and improve customer experience.

1. Improve NPS score

Theresa needs to improve her existing claims processing system. It's complex and highly manual, resulting in lengthy claim resolution times. Needless to say, the customers are not happy.

With IBM Cloud Paks, Theresa is able to leverage built-in AI technology to automate manual processes without the need to staff multiple teams, train them on AI, and hope they can build it. Integrating the solution across the enterprise means it can continually mine processes to identify opportunities to further optimize the business process and greatly improve customer satisfaction, driving higher NPS scores.

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2. Automate claims

Theresa wants to ensure claims processing can operate without interruption and save money through automation, so she and her team can react nimbly to market demands, and ultimately, delight customers.

By modernizing applications, Theresa and her team can take advantage of AI and insights to make more accurate decisions, reduce downtime and reduce escalating costs. With IBM Cloud Pak for Watson AIOps, Theresa and her IT Ops team will have access to explainable ​AI that helps them detect and diagnose complex issues​ by connecting the dots between structured ​and unstructured data ​in real time, minimizing disruption in the automated claims process.

Telefónica, IBM and Red Hat joined forces to leverage hybrid cloud and AI capabilities of IBM Cloud Paks to automate operations and accelerate digital transformation. Learn from their success story.

3. Speed responses

The Chairman and Board of Directors want Theresa to invest in digital strategies to speed market responsiveness while moving to a hybrid cloud architecture, improve security, and continue to find new ways to optimize business processes to drive further efficiencies.

With IBM Cloud Paks, Theresa is able to empower her team to build and modernize applications faster, automate processes to drive efficiency, and secure data and applications to reduce threats and respond to incidents with speed and accuracy. IBM Cloud Pak for Integration helps to connect to core systems such as Guidewire and includes API Connect to enable third-party applications and internal teams to collaborate in a centrally managed ecosystem, reducing costs along the way. Theresa is also able to accelerate integration development and time to market, keeping her company competitive and her Board of Directors pleased with her decisive actions.

Meet Luisa, a claims adjustment manager. See how she uses IBM Business Automation Workflow, RPA and more to automate manual processes and simplify workflows, enabling her team to deliver an exceptional customer experience.

1. Process claims efficiently

Luisa manages a team of insurance claims processors who handle incoming claims and collect data related to the claims. They go through a series of steps to validate information of the insured, verify coverage, and consult with data science and investigation units before offering a settlement. This process is time consuming, and they need a more efficient handling of the claims process.

With IBM Cloud Pak for Business Automation, Luisa's team members can see their assigned claims via their insurance claims dashboard, where details and coverage are automatically validated before they even begin work on the claim. As the dashboard progresses through an automated workflow, they'll know when each task, such as fraud, traffic or weather analysis, in the workflow has been completed. This information is automatically generated from prediction models deployed to a machine learning service, created by the data scientist with IBM Cloud Pak for Data. Luisa and her team can look at the summary of AI analysis of crash images uploaded by the customers and can drill down into the actual images as needed.

2. Provide exceptional CX

In a process burdened with manual tasks and paperwork, customers can become frustrated with long waits for claim resolution, lack of visibility to progress and the amount of data they have to provide.

With IBM Cloud Pak for Business Automation, Luisa's unit is able to provide a better customer experience, such as providing mobile access to a chatbot, the ability to upload photos, and quicker provision of services and settlement. Using Robotic Process Automation (RPA) to automate repetitive ​desktop tasks allows her team to process claims faster with minimal errors associated with human fatigue. It also continuously assesses the workflow for further opportunities to optimize for efficiency, delighting customers with each improved process along the way.

Additionally, Luisa and her team can look at the dashboard to see how they are performing against company KPI, such as number of claims submitted and NPS. Now that the time to complete the claim is 50% faster with the new system, and with their ability to respond to customer queries via the App, she is pleased to see that their NPS score has improved dramatically.

Meet Jill, a data scientist. See how she leverages AutoAI to improve productivity by automating many manual steps to deliver better, more accurate assessments on submitted claims.

1. Access data sources

As a data scientist, Jill needs access to a variety of data sources (weather, structured data like the policy-holder’s information, unstructured data like photos and text from chatbots) that are stored in multiple systems and clouds.

With IBM Cloud Pak for Data, Jill has a consistent environment for working with all types of data — structured and unstructured. Teams are not obstructed based on data types, sources, or shape. And they also have the flexibility to use their preferred open source frameworks and libraries. With the increase in both the quality and quantity of data, Jill and her team can deliver better, more accurate assessments on the claims submitted by insurers.

Scale AI-powered transformation easily by unifying data, tools and talent with IBM Cloud Pak for Data.

2. Build models quickly

Jill needs a mechanism to explore data so she can build models quickly. She also needs a way a way to make models available for easy access by the workflow, versus today, when they are stored on the data scientist’s laptop.

She now builds her models initially using AutoAI, followed by fine tuning the model to deliver business-relevant results. She deploys the prediction model to a machine learning service to make the insights consumable by the intelligent workflow for auto claims process and deliver business outcomes from her Data & AI team.

A team of data scientists at Highmark Health were able to build models quickly to predict – and prevent – sepsis mortality. Learn from their success story:

3. Improve productivity

Jill has been asked to increase her speed of model development and deployment without sacrificing accurate analysis. She also needs a simple way to go from dev to testing to validation to production without disrupting the data scientist’s work with multiple teams of developers and operations leads.

Tools like AutoAI dramatically improve productivity of the data scientist by automating many of the manual steps. Teams are highly productive because they use their tools of choice. And they can also enjoy the integrated support for ML Ops, including model validation and production deployment. This means no time is lost from design, to deployment, to management.

Meet Marco, a security analyst who monitors and secures the insurer's data with a variety of software managed through a unified interface.

1. Submit trusted claim

Marco needs to secure connectivity of the insured to the enterprise via a trusted managed device. This enables the insured to submit a claim in a non-intrusive, secure manner from their non-managed device.

With IBM Cloud Pak for Security, Marco will be able to eliminate potential fraud through automated triggers. Using QRadar, he can monitor and identify threats, and with SOAR he can automate response to security incidents through a unified interface, allowing his team to respond more quickly and effectively.

2. Secure mobile app

With the company's rollout of a new mobile application, Marco needs to ensure that hackers don't abuse the app.

IBM Cloud Pak for Security allows the insurers to quickly identify when a fraudster's device or account is being used. It also has the ability to quarantine or lock the account until the valid user is verified, further securing transactions for both the insured and insurer.