Proposed Improvements

  • Recommendations:

    • Progressive, step-wise, implementation.

    • Use various AI/ML tools and techniques to assist the adjusters.

    • Provide support for low-level, repetitive tasks:

      • Point out areas in need of review,

      • Help with parsing and data extraction,

      • Reduce repetition fatigue.

  • Goals:

    • Bring average processing time from 7h/claim down to 2h/claim.

    • Reduce human error by 80%.

    • Improve fraud detection by 25%.

  • Requirements:

    • More precise measurements of performance:

      • At baseline,

      • After every change/improvement.