Transform your claims processing by making it faster, smarter, and more efficient. An AI-enabled solution can help streamline life insurance claim processing, eliminate fraudulent claims, and reduce human intervention. Adhere to compliance requirements, improve your claims operations, curb expenses, and improve customer satisfaction with a comprehensive low code and AI-powered claims solution.

Features of Newgen’s AI-powered Claims Management Solution for Life Insurance

Multichannel Initiation and Customer Portal

Multichannel Initiation and Customer Portal

Enable case initiation from multiple channels, including customer self-service portal, website, scanning solution, and social media. Customers can get real-time notifications and track the status of submitted claims over the portal. The solution allows the scanning of claims forms and KYC documents for claim initiation, and integration with the core system allows seamless fetching of policy details.

Intelligent Claim-level Processing

Intelligent Claim-level Processing

Auto-retrieve individual policy information by entering key indexing fields, reserve booking via core integration, and manage all claim types such as death, permanent total disability (PTD), temporary total disability (TTD), critical illness, and involuntary loss of employment claims. Claims duplicity can be prevented and flagged, and there are built-in rules to determine claim eligibility.

Client-level Notification

Client-level Notification

Generate a single notification number for claims filed against multiple policies and book claim reserves during the notification stage with the help of AI. Perform de-dupe check to rule out duplicate policy matches against the insured.

Operational Insight and Monitoring

Monitor and measure user efficiency with defined KPIs, ensure transparent and timely life insurance claims processing with escalation matrix and monitoring reports, and effectively track claims processing across departments.

Rule-based Algorithms

Rule-based Algorithms

Leverage built-in rules to automatically classify claims as “fast track” or “non-fast track” and identify admissible/non-admissible claims. An authority matrix can be defined and used to allocate cases among different users. The system can also perform product-based calculation rules for reserve, death benefit, disability benefit, critical illness, and final payable. Claim eligibility rules for policy status, benefits/coverages, waiting/ survival period can also be defined.

Intelligent Claims Assessment

Perform a detailed assessment of each claim with an all-inclusive dashboard, undertake parallel processing for multiple referral activities, and request additional details based on dynamic needs. Generate claim summary sheet and route process based on assessor decisions. The system also supports intelligent data processing for claims triage and system-recommended decisions and the AI/ML algorithm can detect and prioritize fraudulent activity and assign a fraudulent score.

Smart Case Routing and Allocation

Smart Case Routing and Allocation

Automatically route cases based on the adjudicator’s workload and expertise and undertake effective registration, adjudication, tracking, and management of claim submissions using a single interface to track and manage claims. The flexible rule engine can automatically route claims to investigators based on workload and efficiency. The system also supports a transaction-based investigator portal for reports and data upload, enabling real-time communication between the on-field investigators and the system.

Multichannel Initiation and Customer Portal

Multichannel Initiation and Customer Portal

Enable case initiation from multiple channels, including customer self-service portal, website, scanning solution, and social media. Customers can get real-time notifications and track the status of submitted claims over the portal. The solution allows the scanning of claims forms and KYC documents for claim initiation, and integration with the core system allows seamless fetching of policy details.

Intelligent Claim-level Processing

Intelligent Claim-level Processing

Auto-retrieve individual policy information by entering key indexing fields, reserve booking via core integration, and manage all claim types such as death, permanent total disability (PTD), temporary total disability (TTD), critical illness, and involuntary loss of employment claims. Claims duplicity can be prevented and flagged, and there are built-in rules to determine claim eligibility.

Client-level Notification

Client-level Notification

Generate a single notification number for claims filed against multiple policies and book claim reserves during the notification stage with the help of AI. Perform de-dupe check to rule out duplicate policy matches against the insured.

Operational Insight and Monitoring

Monitor and measure user efficiency with defined KPIs, ensure transparent and timely life insurance claims processing with escalation matrix and monitoring reports, and effectively track claims processing across departments.

Rule-based Algorithms

Rule-based Algorithms

Leverage built-in rules to automatically classify claims as “fast track” or “non-fast track” and identify admissible/non-admissible claims. An authority matrix can be defined and used to allocate cases among different users. The system can also perform product-based calculation rules for reserve, death benefit, disability benefit, critical illness, and final payable. Claim eligibility rules for policy status, benefits/coverages, waiting/ survival period can also be defined.

Intelligent Claims Assessment

Perform a detailed assessment of each claim with an all-inclusive dashboard, undertake parallel processing for multiple referral activities, and request additional details based on dynamic needs. Generate claim summary sheet and route process based on assessor decisions. The system also supports intelligent data processing for claims triage and system-recommended decisions and the AI/ML algorithm can detect and prioritize fraudulent activity and assign a fraudulent score.

Smart Case Routing and Allocation

Smart Case Routing and Allocation

Automatically route cases based on the adjudicator’s workload and expertise and undertake effective registration, adjudication, tracking, and management of claim submissions using a single interface to track and manage claims. The flexible rule engine can automatically route claims to investigators based on workload and efficiency. The system also supports a transaction-based investigator portal for reports and data upload, enabling real-time communication between the on-field investigators and the system.

Brands using Newgen Platform
AXA
tokio
Venerable
MAX
Bajaj
Brands using Newgen Platform
AXA
tokio
Venerable
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