Review of current claims processing

  • Claims can come in from multiple mediums:

    • email,

    • fax,

    • phone,

    • web form.

  • All formats have to be transcribed into the web form for better uniformity and processing.

  • Claims have to be processed by (human) claims adjusters.

    • They spend an aggregated average of 7 hours/claim.

    • We estimate that human errors account for $2.5M/year in lost revenue.

    • Another $3.5M/year is likely lost due to insurance fraud.

  • There are a lot of inefficiencies!

    • Adjusters report "workload-fatigue", i.e. making mistakes due to the repetitive nature of the work.

    • It also takes a long time to train new adjusters into the specific policies of the companies.

    • Encoding some of that tribal knowledge into a software product is highly desirable.