umAI for Claims Management takes care of optimized claims management and fraud detection helping you to handle the claims handling process more efficiently. The solution is powered by our proprietary AI Decision Engine.
Optimized Claims Management umAI
Suspicious Score &
Unlocking Textual Data
Using NLP technology, our system extracts all meaningful information from text records and screens it automatically, saving hours of time and simplifies claims processing for adjusters.
Suspicious Score & Fraud Prediction
The AI brain of our Claims Management System scores each claim against an evolving library of hundreds of suspicious scenarios to detect claims that match suspicious patterns before and during the claims handling process, predicting a “suspicious score” for each claim. The system flags suspicious claims and targets them for further investigation, while enabling a “fast track” process for the unsuspicious claims.
Claim Paid Amount Prediction
Our AI engine profiles and benchmarks claims’ paid amounts and predicts the appropriate claim amount to be paid to Claimants taking into consideration the associated “Suspicious Score” and flags any abnormal payment issue.
Causality and Link Detection
With our Causality and Link Detection System you can understand the root cause of potential suspicions, view investigation graphical insights, uncover hidden connections and network relational correlations for efficient claims investigations and management. You can connect between shared indicators for current and other claims (not from the same policyholder) and cross-reference claims to further reduce errors before the claim approval.
umAI’s team of data scientists help you integrate the AI solution into your claims management system. We manage the end-to-end implementation of the system.
- Connect to data sources
- Integrate into your existing systems
- Fully customizable
By working on smart automation of existing workflows, alerting you where to focus your efforts due to anomaly patterns, we increase your process efficiency and enhance your customer experience.
SLA improvements, such as reduction of claims processing times and increased quality of service.
Simplify and focus your investigations
of suspicious claims with structured potential root cause analysis.
Monetary savings and reduced claim paid amount due to avoided improper payments and expenses.
Dynamic resource management.
Standardization in claims settlement mechanics with less dependency on the specific knowledge of your claims settlement agents.
Bottom-up claims reserve calibration.
Intelligence For Everyone
Claims optimization for health insurersLearn More
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