Overview
Odyss transformed the insurance claims adjudication for one of the largest global insurance companies by leveraging the advanced automated system. This initiative significantly enhanced operational efficiency, reduced costs, and improved compliance, leading to better customer satisfaction and streamlined claim settlements.
Problem Statement
Manual methods resulted in inconsistencies and errors, causing delayed settlements
High operational costs due to labor-intensive claim handling
Challenges in meeting compliance standards due to inaccurate interpretations of policy terms
Business Goals
Increase efficiency, reduce the time taken for claim adjudication and improve the accuracy and consistency of claim settlements
Lower the operational costs associated with claims processing
Ensure reliable adherence to regulatory and compliance standards
Solutions
- Odyss addressed the client’s challenges by leveraging its sophisticated automated claims adjudication system. The solution was built around a robust knowledge graph and advanced language models to ensure precise and efficient claims processing.
- Odyss helped develop a comprehensive knowledge graph to standardize the review of policy clauses and regulations. This framework allowed for a unified and consistent approach to interpreting and applying policy terms, reducing the chances of errors and inconsistencies.
- Leveraged LLMs to interface natural language with the knowledge graph. This integration facilitated the seamless processing of textual information, enabling the system to understand and interpret policy terms and claims data accurately.
- Moreover, the client was able to create machine-readable logic representations of policy terms to automate the decision-making processes with the help of Odyss. This automation provided real-time recommendations for consistent and accurate claim settlements, drastically reducing the manual effort required and ensuring compliance with regulatory standards.
Outcome
Efficiency gain and improvement in customer satisfaction scores by 61%
Improved claim processing and increased precision by 8%
Reduced claims operational expenses by 15%
Impact
- Odyss implementation of automated claims adjudication had a positive impact on the client’s operations. With the partnership, the client was able to enhance the efficiency of the claim process while handling a higher volume of claims without increasing operational costs. Not to mention the automation and use of advanced technologies reduced discrepancies through manual errors.
- The client was able to experience a streamlined process that improved its customer experience. The customer satisfaction scores increased substantially due to the faster and more reliable claim adjudication that eventually led to shorter waiting periods and more predictable outcomes.
- With the reduction in operational expenses, the client was able to allocate resources more seamlessly, focusing on other critical areas of its business. The adherence to regulatory standards ensured that the company remained compliant.
- Overall, the collaboration with Odyss not only addressed the immediate problems faced by the insurance company but also positioned them for long-term success in a highly competitive industry.
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