Cloud Pak for Data Group

Insurance Claims 

Tue April 21, 2020 11:55 AM

Process insurance claims more efficiently

Processing claims are one of the biggest cost drives for insurance companies. It makes up almost 30% of an insurer's operating costs on average1. However, up to 70% of claims can be handled automatically, according to industry estimates2. This would save insurers time and money, and improve customer satisfaction.

Insurance companies can use our accelerator to process claims more efficiently to save time and money.

If a claims agent knows the likely outcome and cost of a claim, she can then make more appropriate decisions. For example, she might choose to settle the claim immediately instead of sending it through a long process with the same end result but higher business costs.

The accelerator will use machine learning models to predict the most likely outcomes and settlement amounts of accidental damage claims.

Inefficient claims handling increases business costs and reduces customer satisfaction levels. Part of this inefficiency comes from claims agents not having full visibility of the process and likely outcomes.

The accelerator will provide AI predictions and the key factors that influenced the AI predictions. This will help the agent make more efficient decisions and explain the rationale behind those decisions to clients if they ask. Insurance companies can reduce business costs, and improve customer satisfaction levels and Net Promoter Score (NPS).

The AI predictions will also be monitored for bias for regulatory purposes. This accelerator will specifically monitor bias in claim outcomes for customers of different ages. Any detected bias will be corrected, helping the claims handling agent make fair and more appropriate decisions.

References:

1McKinsey & Company (2016), 'From transparency to insights: McKinsey's insurance cost benchmarking 2016'. Accessed on 25 March 2020.

2Jane Disney (2019), 'Digital, fully automated claims is not a 2030 dream - It's possible today'. Digitalist Magazine. Accessed on 25 March 2020.

Sample Application

A sample application is provided showing how the Claims Handling agents experience can be enhanced using the deployed models which have automatically been monitored for bias.

Prerequisites

Required services: To use the industry accelerators, you must install one or more of the following services on IBM® Cloud Pak for Data

Service Required for
Watson Knowledge Catalog Importing data governance artifacts, such as business terms and categories. See Installing Watson Knowledge Catalog.
Watson Studio Importing data science assets to an analytics project. See Installing Watson Studio.
Watson Machine Learning Deploying analytical models. See Installing Watson Machine Learning.
Watson OpenScale Infuse your AI with trust and transparency. Understand how your AI models make decisions to detect and mitigate bias. See Installing the Watson OpenScale service.

Importing the accelerator

To use this accelerator on Cloud Pak for Data v2.5.0.0, complete the following steps:

  1. Download the InsuranceClaims-industry-accelerator.tar.gz file.
  2. Extract the contents of the package.
  3. Follow the instructions in the README.pdf.

Release Notes

This accelerator has been verified on:

  • Cloud Pak for Data v2.5.0.0

About the developer:

IBM

Terms and Conditions

The terms under which you are licensing IBM Cloud Pak for Data also apply to your use of the Industry Accelerators. Before you use the Industry Accelerators, you must agree on these additional terms and conditions that are set forth here. This information contains sample modules, exercises, and code samples (the code may be provided in source code form ("Source Code")) (collectively "Sample Materials").

License: Subject to the terms herein, you may copy, modify, and distribute these Sample Materials within your enterprise only, for your internal use only; provided such use is within the limits of the license rights of the IBM agreement under which you are licensing IBM Cloud Pak for Data. The Industry Accelerators might include applicable third-party licenses. Review the third-party licenses before you use any of the Industry Accelerators. You can find the third-party licenses that apply to each Sample Material in the notices.txt file that is included with each Sample Material.

Code Security: Source Code may not be disclosed to any third parties for any reason without IBM's prior written consent, and access must be limited to your employees who have a need to know. You have implemented and will maintain the technical and personnel focused security policies, procedures, and controls that are necessary to protect the Source Code against loss, alteration, unlawful forms of processing, unauthorized disclosure, and unauthorized access. You will promptly (and in no event any later than 48 hours) notify IBM after becoming aware of any breach or other security incident that you know, or should reasonably suspect, affects or will affect the Source Code or IBM, and will provide IBM with reasonably requested information about such security incident and the status of any remediation and restoration activities. You will not permit any Source Code to reside on servers located in the Russian Federation, the People's Republic of China, or any territories worldwide in which the Russian Federation or People's Republic of China claim sovereignty (collectively, "China or Russia"). Company shall not permit anyone to access or use any such Source Code from or within China or Russia, and Company will not permit any development, testing, or other work to occur in China or Russia that would require such access or use. Upon reasonable written notice, IBM may extend these restrictions to other countries that the United States government identifies as potential cyber security concerns. IBM may request that you verify compliance with these Code Security obligations, and you agree to cooperate with IBM in that regard.

General: Notwithstanding anything to the contrary, IBM PROVIDES THE SAMPLE MATERIALS ON AN "AS IS" BASIS AND IBM DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTIES OR CONDITIONS OF MERCHANTABILITY, SATISFACTORY QUALITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, AND ANY WARRANTY OR CONDITION OF NON-INFRINGEMENT. IBM SHALL NOT BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY OR ECONOMIC CONSEQUENTIAL DAMAGES ARISING OUT OF THE USE OR OPERATION OF THE SAMPLE MATERIALS. IBM SHALL NOT BE LIABLE FOR LOSS OF, OR DAMAGE TO, DATA, OR FOR LOST PROFITS, BUSINESS REVENUE, GOODWILL, OR ANTICIPATED SAVINGS. IBM HAS NO OBLIGATION TO PROVIDE MAINTENANCE, SUPPORT, UPDATES, ENHANCEMENTS OR MODIFICATIONS TO THE SAMPLE MATERIALS.


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