How Prudential Assurance is automating its e-claims process with AI

Following PEX Network’s PEX Live: OPEX APAC 2022 event that took place on 4 – 5 October, we take a look back at the opening session and highlight the key insights that were shared.

The session titled CASE STUDY: The Prudential Assurance Claims Transformation Journey to Drive Efficiency was presented by Madhan Seduraman, head of operational excellence (OPEX) center of excellence (CoE) at Prudential Assurance Company. In the session, Seduraman offered an overview of the work done by the company’s CoE and detailed an end-to-end automated e-claims process which applies three separate artificial intelligence (AI) engines.

According to Seduraman, Prudential Assurance Company was experiencing a significantly larger amount of insurance claims through email at the onset of the pandemic than it had previously. As many of these claims would have been submitted as hard copies prior to the pandemic, the process for handling e-claims was deemed insufficient in its capacity for dealing with them.

The solution was the development of an end-to-end automated e-claims process that utilizes three separate AI engines alongside optical character recognition (OCR) technology.

Prudential Assurance Company’s automated e-claims process (Source: PEX Live: OPEX APAC 2022)

The process utilizes the first AI engine to classify incoming e-claims submissions into pre-determined categories, such as ‘pre-hospitalization’ and ‘post-hospitalization’ claims. This automatically triggers two processes in parallel: one which archives the data in a repository and another which automatically determines the content of the submission via the second engine, AI-powered OCR.

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The claims are then automatically registered into the business system before the third AI engine in the process begins automatic adjudication. This stage utilizes a fraud engine which applies a risk score to the claim before straight-through-processing (STP) is applied at the end of the process.

STP is a method utilized by financial institutions to speed up processes by having claims automatically paid into the correct account if they are deemed valid via the business’ validation process.

The use of AI and OCR technology has allowed Prudential Assurance company to progress from an e-claims process that was simply an e-mail inbox, to one which automatically handles e-claims from start to finish with no need for human intervention.

Has your business leveraged AI or OCR? Let us know in the comments below.