Medical claims processing: AI is being used to process the cashless claims put before the Third Party Administrator (TPA) by the hospital. The policy related information; the doctor’s diagnosis and the post hospitalisation course of action recommended by the doctor is ingested in the AI algorithm, which decides the admissibility of the case. This was decided by the doctor, earlier. Based on the case admissibility, a ML program decides on the optimum claims amount to be sanctioned based on the overall policy amount. For example, if the claim is for the amount of Rs one lakh, then eighty thousand is sanctioned based on more information and the rest of the amount is cleared later. The ML program sends a message to the effect to the TPA desk at the hospital.
This entire process takes about ninety seconds. The same process when done manually took about 3 to 4 hours. “We have started this a few months back for corporate health claims. This started with a single digit success rate. In the last few weeks we have reached at fourty percent. In effect, of all the corporate health claims, over fourty percent are processed using the AI/ML process. The rest of the sixty percent goes through human intervention. The doctors can now dedicate more time doing the investigation for more complex cases leaving the simple cases for AI to process,” says Girish Nayak, CTO, ICICI Lombard GIC.
Policy renewal: Typically when the motor policy is due for renewal, the surveyor comes and checks the vehicle for any damages. This process has been made AI enabled. The vehicle owner can take a few photographs and upload it for the AI algorithm to check for any damage. In case the vehicle has dents, spots, any kind of damage – then is it acceptable or not. It decides, based on the photographs whether the policy can be renewed or not. This has been operational since December 2018. Currently, close to sixty percent of motor policy renewals are processed through AI.
The motor renewal process, when done manually used to take about 72 hours. Now, it happens almost instantly. The surveyor has to visit the place personally, if the motor renewal case isn’t qualified to be handled by AI.
ICICI Lombard will also apply AI in motor insurance claims, wherein the algorithm will decide the claim amount to be released based on the damage caused to the motor. “ The AI enabled motor claims insurance will go to production soon,” informs Nayak.
Fraud detection: There are certain hard coded triggers that are set for isolating the claims to be sent for further investigation. They are potentially, fraudulent claims. “Before, this was done manually but now, it’s being done by AI. It’s giving us results, which are as good as was previously delivered by fraud detection team,” says Nayak. It will only improve over a period of time as the algorithm learns and fine-tunes the understanding of the triggers. The technology has been built by the internal team of data scientists at ICICI Lombard.
The entire processing for AI is done on cloud. “Most of the technology for AI has been built by the internal team of data scientists. This gives us a competitive edge. However, we started off working with a couple of vendors in the initial days,” concludes Nayak.