Insurance companies pay out massive amounts
of money in fraudulent claims, totaling over $80 Billion paid out annually. Fraudulent claims account for 5-10% of all
insurance claim costs. Automation Anywhere reduces false claims in
the following ways: It automatically extracts claim data to shorten
claim handling times. It isolates and triages potential fraudulent
claims for further analysis. It improves customer satisfaction by reducing
over-all claim processing times and lowering costs. And finally, it provides automated analytics
and insights about claims to help you make better decisions. The process starts with a submission and extraction
of basic claim information. This may come from an email or other source
during the first notice of loss. The claim data is then processed through fraud
detection, triage, and assigned to a team for further investigation. Or, it can be sent to a claims adjuster for
a normal judication and payment if no signs of risk are present. The policy holder starts the claim process
by submitting a claim via email or other channels. This claim information is then automatically
processed using a series of Automation Anywhere RPA and IQ Bot Task Bots. As emails arrive, the claim form’s data is
extracted and placed in a claim-processing queue. The IQ Bot extracts the claim data using machine
learning and creates a .CSV file from the data. This data includes such information as name,
address, date, policy number, telephone number, email address, date and time of incident,
and anything else that is required to process the claim. The claim is next passed to a bot that examines
the claim data for signs of possible fraud. This bot uses cognitive analytics to predict
the likelihood the claim is fraudulent. Claims that are determined to have a high
probability of fraud are triaged into a special queue for analysis by experts in the special
investigation unit. To insure those claims are evaluated quickly,
the Automation Anywhere system generates a notification to the SIU that an investigation
and followup is needed. An additional benefit of the Automation Anywhere
system is that claim analytics and reporting can easily be generated around the claim process
to help managers optimize operational efficiency and effectiveness. For example, Bot Insight takes business insights
to the next level, with transparent dashboards to monitor claims process, front counts, processing
time and anything else needed to assess the health of the operations. Automation Anywhere Enterprise RPA and IQ
Bot reduces claim processing costs, detects fraud with AI models, increases customer satisfaction
with quick end-to-end automation, and provides insights into claims processing trends via
analytics. For more information, go to