NewgenONE AI Platform
Streamline Insurance Claims with AI-Powered Speed and Fairness
Transform claims adjudication across Life, Motor, General, and Health lines with an AI-first solution that extracts data, detects fraud, and recommends fair, faster decisions
Key Features of NewgenONE Claim Adjudication Agent for Insurance
AI-powered Document Extraction & Validation
Effortlessly process complex documents like medical records, damage reports, and claim forms with AI that reads, extracts, and validates data accurately. Ensure all critical details are captured correctly, reducing errors and speeding up the claims process.
Automated Claim Sorting and Prioritization
Simplify claims management by letting AI automatically triage claims into simple or complex cases. Routine claims are processed without manual intervention, while complex cases are prioritized, intelligently sorted for efficiency and routed to adjudicators with relevant data in an organized format.
AI-driven Fraud Detection and Alerts
Stay ahead of fraudulent claims with AI that analyses patterns and flags suspicious activity in real time. By examining claim details, policyholder history, and external data, it provides clear, actionable alerts to guide your review. Identify and address potential fraud to protecting your organization while maintaining trust and fairness in the claims process.
Omnichannel Claim Data Collection
Seamlessly access claim data from web forms, mobile apps, chatbots, or social media. This feature consolidates first notice of loss (FNOL) data into a single, organized view. Start reviews with clean, accurate information to save time and improve decision quality.
AI-supported Decisions and Explanations
Make confident decisions with AI that provides transparent recommendations and easy-to-understand explanations. Every suggestion, whether for payouts or claim rejections, comes with clear reasoning, ensuring you can justify decisions during audits. This feature supports adjudicators by combining AI precision with human judgment, maintaining compliance and clarity.
Seamless Integration with Insurance Systems
Work efficiently with a solution that integrates with your existing insurance systems, such as policy administration or CRM tools. All claim-related data is unified in one accessible view, eliminating the need to switch between platforms. This connectivity streamlines your adjudication process, providing a complete picture of each claim to support faster, informed decisions.
AI-powered Document Extraction & Validation
Effortlessly process complex documents like medical records, damage reports, and claim forms with AI that reads, extracts, and validates data accurately. Ensure all critical details are captured correctly, reducing errors and speeding up the claims process.
AI-driven Fraud Detection and Alerts
Stay ahead of fraudulent claims with AI that analyses patterns and flags suspicious activity in real time. By examining claim details, policyholder history, and external data, it provides clear, actionable alerts to guide your review. Identify and address potential fraud to protecting your organization while maintaining trust and fairness in the claims process.
Omnichannel Claim Data Collection
Seamlessly access claim data from web forms, mobile apps, chatbots, or social media. This feature consolidates first notice of loss (FNOL) data into a single, organized view. Start reviews with clean, accurate information to save time and improve decision quality.
AI-supported Decisions and Explanations
Make confident decisions with AI that provides transparent recommendations and easy-to-understand explanations. Every suggestion, whether for payouts or claim rejections, comes with clear reasoning, ensuring you can justify decisions during audits. This feature supports adjudicators by combining AI precision with human judgment, maintaining compliance and clarity.
Seamless Integration with Insurance Systems
Work efficiently with a solution that integrates with your existing insurance systems, such as policy administration or CRM tools. All claim-related data is unified in one accessible view, eliminating the need to switch between platforms. This connectivity streamlines your adjudication process, providing a complete picture of each claim to support faster, informed decisions.
Use Cases of NewgenONE Claim Adjudication Agent for Insurers
AI-driven Medical Claims Processing for Health Insurance
Effortlessly process health insurance claims with an AI model that extracts and validates critical data, such as diagnosis codes and treatment details, from medical records and billing forms. Get a clear, organized view of all relevant information, to make swift, accurate decisions while ensuring compliance with industry regulations.
Automated Damage and Claims Analysis
Simplify claims adjudication across the insurance value chain by using AI to analyze documents, photos, medical reports, and damage assessments. Routine claims are processed quickly for faster settlements, while complex cases are routed with structured insights to ensure accurate evaluations, consistent outcomes, and improved efficiency across life, health, motor, and general insurance claims.
Intelligent Fraud Screening for Insurance Claims
Safeguard insurance claims with AI that screens claim details, policyholder history, and external data to identify potential fraud. This solution provides adjudicators with clear, actionable alerts and explanations, enabling focused reviews and streamlined adjudication.
Transparent Compliance for Claims Audits
Ensure regulatory compliance with AI that provides traceable recommendations and plain-language explanations for every claim decision, whether approving payouts or escalating cases. Comprehensive audit trails and compliance reports help adjudicators to simplify adherence to global regulatory frameworks.
AI-driven Medical Claims Processing for Health Insurance
Effortlessly process health insurance claims with an AI model that extracts and validates critical data, such as diagnosis codes and treatment details, from medical records and billing forms. Get a clear, organized view of all relevant information, to make swift, accurate decisions while ensuring compliance with industry regulations.
Automated Damage and Claims Analysis
Simplify claims adjudication across the insurance value chain by using AI to analyze documents, photos, medical reports, and damage assessments. Routine claims are processed quickly for faster settlements, while complex cases are routed with structured insights to ensure accurate evaluations, consistent outcomes, and improved efficiency across life, health, motor, and general insurance claims.
Intelligent Fraud Screening for Insurance Claims
Safeguard insurance claims with AI that screens claim details, policyholder history, and external data to identify potential fraud. This solution provides adjudicators with clear, actionable alerts and explanations, enabling focused reviews and streamlined adjudication.
Transparent Compliance for Claims Audits
Ensure regulatory compliance with AI that provides traceable recommendations and plain-language explanations for every claim decision, whether approving payouts or escalating cases. Comprehensive audit trails and compliance reports help adjudicators to simplify adherence to global regulatory frameworks.
Core Components of NewgenONE Claim Adjudication Agent
AI-powered Claims Processing Engine
Leverages advanced AI to extract and validate data from diverse claim documents, such as medical records and damage reports. This component organizes data into a unified view.
Decision Automation & Configurable Rules
Implements configurable business rules to automate claim eligibility verification, routing, and approvals while ensuring compliance with industry regulations.
Conversational AI Decision Assistant
Acts as an interactive assistant, providing adjudicators with clear recommendations and plain-language explanations for claim decisions, such as payouts or claim rejection.
Omnichannel Data Integration Platform
Unifies claim data from multiple sources like web portals, mobile apps, and call centers into a single, actionable interface. This component enables seamless data access and real-time policyholder communication.
AI-powered Claims Processing Engine
Leverages advanced AI to extract and validate data from diverse claim documents, such as medical records and damage reports. This component organizes data into a unified view.
Decision Automation & Configurable Rules
Implements configurable business rules to automate claim eligibility verification, routing, and approvals while ensuring compliance with industry regulations.
Conversational AI Decision Assistant
Acts as an interactive assistant, providing adjudicators with clear recommendations and plain-language explanations for claim decisions, such as payouts or claim rejection.
Omnichannel Data Integration Platform
Unifies claim data from multiple sources like web portals, mobile apps, and call centers into a single, actionable interface. This component enables seamless data access and real-time policyholder communication.
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