Automated Claims Adjudication

for a leading insurance provider in the P&C segment.

The client is one of the largest Property & Casualty Insurance service providers offering services in multiple geographies across the globe.

The Ask

Automate the claims adjudication process from the traditional manual process.

Bring down the processing costs of claims adjudication to get an edge over the competitors.

Bring down the processing time of claims adjudication to get an edge over the competitors.

Solution

Using the Knowledge Graphs, we structured policy clauses, regulations, claims data etc. and created machine-readable logic representations of policy terms for easy automation.

Create machine-readable logic representations of policy terms and automated processes to provide real-time recommendations for consistent decisions.

Automated computable contracts generation and created machine-readable logic representations of policy terms.

Technology Accelerators

RDF Graph Database

GPT-4 AI Engine

React on Frontend

Impact

Data Integration

Complexities in merging diverse data sources

NLP Accuracy

Achieving precise natural language understanding.

Compliance

Adhering to evolving legal and regulatory standards.