End to End Claims Automation with Dociphi for a Leading U.S. Insurer, Achieving Faster Turnaround Times and Reducing Operational Costs.

Quantiphi partnered with a leading U.S. insurer to automate their claims adjudication process using Dociphi, driving efficiency gains and cost reduction. By leveraging AI-powered document processing, the client was able to streamline operations and significantly improve processing times.

Read how Dociphi achieved over 90% extraction accuracy, increased operational efficiency by ~30%, and reduced claims processing turnaround time to within one day.

About the Client

The client is a large American insurance company processing approximately $13M in claims annually. With a workforce of around 10,000 employees, the company faced significant challenges in handling claims and underwriting processes manually.

Problem Statement

The client struggled with high error rates and operational costs due to the varying templates and manual processing of documents by knowledge workers. Claim adjusters had to manually review numerous unlabelled or semi-structured documents to determine claim amounts, leading to delays, inconsistency, and alignment challenges with business priorities. Additionally, underwriting teams faced productivity issues, requiring manual navigation through extensive underwriting guides exceeding 100 pages.

Challenges

• High Error Rate: Manual document processing frequently led to errors, particularly due to the varied formats and structures of incoming claims documents—ranging from scanned images and PDFs to handwritten forms. The lack of standardization meant that human errors were common, affecting the accuracy of claims adjudication.
• Operational Costs: The manual processing of claims documents not only increased the time required to process claims but also inflated labor costs, as the client had to maintain a large team of adjusters and underwriters dedicated to reviewing documents. The company was incurring significant expenses in both labor and error correction efforts, eroding profit margins.
• Inefficiency: The manual approach also resulted in delays in claims and underwriting processes. These delays caused bottlenecks in customer service, impacting the client’s ability to provide timely and accurate coverage assessments. Furthermore, the underwriting team’s inability to quickly navigate underwriting guides made it difficult for them to deliver assessments in line with market demands and customer expectations.

The Solution

Quantiphi deployed its AI-powered document processing platform, Dociphi, to streamline the client’s claims adjudication and underwriting processes. Dociphi was leveraged for a variety of document processing tasks, including automated data extraction, QnA, and summarization tailored specifically to the needs of Claim Adjusters and Underwriters. The solution automated repetitive manual tasks, significantly reducing processing time, improving decision-making consistency, and aligning the workflow with the client’s business goals and priorities.

Key Features of Dociphi:

• AI-Powered Document Processing: Efficiently handles various document formats, automating data extraction to reduce manual effort and speed up processing.
  
• QnA and Summarization: Provides quick access to key policy information through AI-driven QnA and summarization, improving decision-making speed.
  
• Integration with Gen AI: Supports claim reviewers with a Gen AI bot that offers insights and recommendations for complex cases, ensuring accuracy and consistency.
  
• Human-in-the-Loop: Combines AI automation with human oversight, ensuring precise decision-making and handling of sensitive or complex scenarios.

Results and Impact Created

Dociphi significantly improved the client's claims processing workflow:

• Increased Efficiency: The AI-driven solution achieved over 90% extraction accuracy and 95% classification accuracy, significantly reducing human error. This improved accuracy meant that fewer claims required manual intervention, reducing processing time and ensuring faster payouts to customers.
• Reduced Turnaround Time: Claims processing turnaround time was reduced to within one day, a remarkable improvement from the previous timelines that often extended several days. This reduction not only aligned with the company’s SLAs but also enhanced the customer experience, leading to improved satisfaction and trust in the company's services.
• Enhanced Data Access: The solution’s robust QnA and summarization features made it easier for claim adjusters to retrieve key data points, such as policy clauses and coverage limits, improving decision-making speed. Underwriters also benefited from enhanced access to condensed policy information, enabling faster evaluations.
• Operational Cost Reduction: Dociphi delivered a substantial operational cost reduction, with a 30% increase in efficiency leading to lower labor costs and minimized rework. This contributed to a more profitable operation, allowing the client to reinvest savings into core business functions.

Ready to Transform Your Claims Processing with Dociphi?

Leverage the power of Gen AI to streamline your document processing, reduce operational costs, and accelerate claims adjudication. Discover how Dociphi can intensify your claims operations with cutting-edge automation and AI-powered insights. Get in touch with us today to explore how Dociphi can elevate your business.