The integration of advanced technologies like artificial intelligence (AI) and automation is revolutionizing the insurance industry, specifically in managing insurance claims. Insurance firms handle vast quantities of unstructured data, a significant challenge for ensuring efficient operations. This case study outlines how a leading Nordic insurer modernized its claims management process through an AI-powered solution supported by EY teams. The overarching objective was streamlining operations, enhancing agent capabilities, and ultimately transforming the company’s approach to claims processing.
Challenges in Traditional Claims Management
The insurer faced several challenges with its existing claims management workflow. Each claim required manual processing, comprising numerous repetitive and complex tasks performed by agents. Complicating matters further, this process involved various unstructured data sources—bills, invoices, receipts from pharmacies and clinics, and detailed medical treatment documents. These documents needed meticulous analysis and categorization by agents, making the entire procedure time-consuming and reducing customer service efficiency. This labor-intensive system resulted from the insurer’s limited technological infrastructure that did not support end-to-end automation.
The manual nature of the process not only slowed down operations but also increased the likelihood of human error, further complicating claims management. These inefficiencies were particularly evident in the time it took to handle each claim, leading to delays and customer dissatisfaction. Recognizing these challenges, the insurer sought a transformative solution to modernize and streamline its claims processing. The goal was to reduce the operational burden on agents while improving accuracy and efficiency to enhance overall customer service.
Collaboration with EY for Technological Transformation
Recognizing the need for transformation, the insurer collaborated with EY teams to reassess its technological infrastructure and business requirements. EY’s goal was to develop an AI-based system that could automate routine activities within the claims management process. The intention was to alleviate agents from mundane tasks, enabling them to focus on enhancing customer relationships by leveraging insights from AI. The collaboration was also aimed at ensuring a smooth transition from manual to automated processes without disrupting ongoing operations.
A significant aspect of this approach was human-centered transformation, facilitating the insurer’s employees to collaborate effectively with AI technologies to achieve impactful outcomes. This collaboration aimed to create a seamless integration of AI into the existing workflow, ensuring that the technology complemented rather than replaced human efforts. EY’s team worked closely with the insurer to understand the specific challenges and requirements, customizing the AI solution to address the unique needs of the organization.
Implementation of EY Fabric Document Intelligence
A critical tool in this transformation was EY Fabric Document Intelligence, an AI-powered solution developed by EY wavespace™ Madrid and incorporated within EY Fabric. This advanced technology converts semi-structured and unstructured documents into structured, actionable data. It involves machine learning and optical character recognition (OCR) built on Python, and it operates within an EY-secured cloud environment. The use of secure cloud infrastructure ensured that sensitive data was protected, complying with privacy regulations and internal security standards.
This solution was customized and scaled to meet the insurer’s specific requirements, allowing the handling of large volumes of claims data more efficiently. The implemented process begins with agents uploading scanned document copies into EY Fabric Document Intelligence, where image cleansing is performed, removing backgrounds, correcting rotations, and reducing noise to enhance quality. This initial preprocessing step improved document clarity, making it easier for the AI system to accurately extract and interpret data. The solution was designed to be user-friendly, ensuring minimal disruption to the agents’ workflow during the transition to the new system.
Enhancing Data Processing and Efficiency
The system then undertakes document preprocessing and layout analysis, using OCR and natural language processing (NLP) to convert and classify unstructured data into structured formats. Subsequently, this structured data is transmitted to the insurer’s core claims system for further processing. As the system processes more documents over time, its performance continually improves, offering sustained value and insights for the insurer. The machine learning component enabled the system to learn from each processed document, enhancing its accuracy and efficiency over time.
This transformative AI-based solution brought notable improvements, including near real-time processing of claim documents. Approximately 70% of documents fed into the system were correctly extracted and interpreted, significantly accelerating decision-making. Consequently, agents could dedicate more time to building meaningful customer relationships, thus enhancing service quality and fostering trust. The increased efficiency also allowed the insurer to handle a higher volume of claims, improving overall throughput and reducing backlogs.
Achieving Transparency and Control
The system also offered transparency, as the data and outputs are controlled through set confidence levels, ensuring the insurer maintained authority over the AI operations. This transparency was crucial in building trust within the organization and with customers, as it demonstrated the insurer’s commitment to maintaining high standards of accuracy and reliability. The ability to set confidence levels allowed the insurer to review and validate the AI’s decisions, ensuring consistency and reducing the risk of errors.
The successful implementation of the AI solution substantially contributed to the insurer’s business objectives, including global expansion. The enhanced operational efficiency and improved customer service garnered interest across the organization, prompting further exploration of modernization opportunities. The positive outcomes also served as a benchmark for other departments and processes, showcasing the potential benefits of AI integration beyond claims management. The insurer’s leadership recognized the value of continuing to invest in advanced technologies to maintain a competitive edge in the evolving insurance market.
Redefining Organizational Structure with AI
The AI solution did more than automate data processing; it redefined the entire organizational structure, showcasing how advanced AI technologies could drive exponential industry transformation. EY’s human-centric approach sought to empower individuals within the insurer, fostering collaboration between agents and AI to create significant long-term value. This human-centered approach ensured that employees were not left behind in the technological transformation.
Instead, they were equipped with the tools and knowledge to work alongside AI, enhancing their roles and contributing to the overall success of the organization. The integration of AI encouraged a shift in the workforce’s skillset, with employees focusing on higher-value tasks such as strategic decision-making and customer engagement. This shift not only improved job satisfaction but also positioned the insurer to better meet the demands of a rapidly changing industry landscape. The insurer’s journey demonstrated how AI could be a catalyst for positive change, driving both operational efficiencies and cultural transformation.
Future Prospects and Industry Implications
Incorporating advanced technologies like artificial intelligence (AI) and automation is transforming the insurance sector, particularly in claims management. Insurers face the challenge of handling large volumes of unstructured data, which is essential for maintaining operational efficiency. This case study highlights how a prominent Nordic insurance company upgraded its claims management system with an AI-driven solution, aided by EY teams. The primary goal was to streamline operations, enhance agents’ capacities, and fundamentally change the company’s method for processing claims. The integration aimed to reduce manual effort and increase accuracy, which in turn, improved customer service and satisfaction. By leveraging AI, the insurer was able to process claims faster, reduce errors, and free up human agents for more complex tasks, leading to a more efficient and responsive service. This transformation story underscores the significant impact that modern technology can have on traditional industries, paving the way for a more automated and reliable future in insurance claims management.
