Review of current claims processing

  • Claims can come in from multiple mediums:

    • email

    • fax

    • phone

    • web form

  • All formats will have to be transcribed into the web form for better uniformity

  • 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.