Artificial Intelligence in the Claims Process

Innovation Project Summary Cookhouse Lab

Artificial Intelligence in the Claims Process

Chatbots provide a huge potential to improve customer service, engagement, sales and real-time access to information.

2

WEEKS

TORONTO

2017

3

MEMBERS

1

MVP

Problem

How can an automated AI chatbot be used to simplify claims submission process, remaining easy and intuitive to use?

Claims – an unpleasant customer experience. Can chatbots make customers happy?

WHY?

The Current Claims Management Experience Pain Points

SEE

SAY & DO

HEAR

THINK & FEEL

DISCOVERY

Can a chatbot make a customer happy?

Can AI help us service clients more efficiently?

With millennials being the next generation and major target market, as an industry, we need to stay current with their service expectations.

A timeline with possible ideas and features that can be implemented today and into the future.

SOLUTION

The final output of the project was a Portfolio Solution that included three different products.

As the sprint was two weeks, our chatbot scope was limited to initiating a claim and starting the FNOL (First Notice of Loss) process with the gathering of information.

Testing results showed that AiiA was intuitive and interactive for the simple straightforward scenario that we designed.

We challenged each other to find new ways to educate AiiA for continued growth and future development. Collaboration continued in the testing stages to review and iterate the flow with enhanced customer experience as our goal.

Innovation Project Solutions AI in claims

Once client has authenticated by signing in, the bot has access to the policies that are linked to him and interacts accordingly to what is available to choose from.

AiiA gives simple options to go through step by step in order to initiate a First Notice if Loss. With user-friendly choices to click on in order to guide the client through the process. It also allows to capture the details of the claim.

Innovation Project solutions AI in claims

ESTIMATED IMPACT

Can set up an infinite number of claims at the same time.

Information gathering of all claim details.

Launches a digital process that reduced cycle times by up to 70%.

Increases profitability for all the stakeholders.

CustomerServ

Customer Service

improvement
asks the right questions and makes sense of the information received and provided

timesaving

Cycle Time

decrease
improving efficiency and productivity by reducing calls, emails and voice inquiries

AIclaims

Claim Process

improvement
live chat with Chatbot available 24/7, easy to use, pre-populated answers

RESULTS

In this two-week sprint, the project team learned how chatbots and AI work, focusing on how a chatbot must be designed and implemented to significantly improve the experience of claims notification and management.

4

Empathy Maps

5

User Tests

37

Surveys

5

Communication Trees

1

MVP

3

Prototype iterations

1

Innovation Report

3

Project Presentations

PARTICIPANTS

We also offer intro sessions that provide insurance professionals with the opportunity to experience our Cookhouse Labs methodology and a sneak peek at what it’s like to co-create and collaborate with our global community. If you are not a Cookhouse Labs member and are interested in finding out more, check out our membership benefits!

Blockchain & Group Benefit Coordination

Innovation Project Summary Cookhouse Lab

Blockchain & Group Benefit Coordination

Many processes within the insurance industry are complicated and manual. Blockchain technology offers the opportunity to streamline these multiparty processes.

4

WEEKS

TORONTO

2017

4

MEMBERS

1

MVP

Problem

How might we eliminate the complexity of the coordination of benefits paramedical claims process?

Streamlining manual and complex multi-party processes

WHY?

The Current COB Experience Pain Points

CUSTOMER

SERVICE PROVIDERS

INSURER

ADJUDICATORS

DISCOVERY

What should this process look like in today’s digital age?

How can policy holders have a more seamless process similar to dental claims?

Can policy holders submit data once and have the process automated between insurers?

Typical 30 days process is reduced to only 10 minutes

SOLUTION

The team created a mockup to simulate the submission, adjudication, and validation from two different insurance carrier perspectives.

The solution, named Clowder by the project team, is focused on eliminating the need for plan members (who have multiple health coverages) to re-submit their paramedical claim to the second & subsequent insurers by using Blockchain hyperledger fabric technology. In addition, Clowder is a proof of concept for how we can leverage Blockchain technology within the insurance industry.

Group Benefits Coordination 01

In theory, any number of insurance providers and customers may be added to the solution. This would allow, for example, a single claim to be adjudicated by more than two insurers.

Group Benefits Coordination02

ESTIMATED IMPACT

Brings improved data quality through new digital tools.

Shares an immutable record of the claim across multiple insurers.

Simplifies claim process and identification of primary payer for policy holder.

costefficiet

COB Cost

Reduction resulting from resubmissions and calls associated with error in customer COB claim process

Caseunderwrite

Fraud

increase due to reliable, standardized EOB documentation through blockchain implementation

timesaving

Claim Submission

simplified, transparent, faster ensurers information consistency through collaboration

RESULTS

In this four-week sprint, the team aimed to design the minimum viable product (or MVP) to test with real customers.

5

Empathy Maps

34

User Interviews

66

Surveys

30

Wireframes

16

MVP Screens

3

Prototype Iterations

1

Innovation Report

2

Project Presentations

PARTICIPANTS

We also offer intro sessions that provide insurance professionals with the opportunity to experience our Cookhouse Labs methodology and a sneak peek at what it’s like to co-create and collaborate with our global community. If you are not a Cookhouse Labs member and are interested in finding out more, check out our membership benefits!

Delays in APS

Innovation Project Summary Cookhouse Lab

Delays in APS

A leading cause of delays in life and health insurance policy issue is often due to time lags in receiving the Attending Physician Statement (APS) also known as Third Party Reports and how that impacts the underwriting process.

12

WEEKS

TORONTO

2017

7

MEMBERS

1

MVP

Problem

Customers are waiting months to recieve life and living benefits coverage due to poor data quality, lack of physician motivation and paper based process culminating in long APS cycle times.

Disrupting a +30 year old process

WHY?

The APS Experience Current Pain Points

APPLICANT

BROKER/ ADVISOR

INSURER

PHYSICIAN

DISCOVERY

Typical 90 days process is reduced to only 2 weeks

What should this process look like in today’s digital age?

How can we expedite the Third Party Reports request process?

How can we provide a risk relevant synopsis of these reports to the underwriter for a faster risk premium classification?

SOLUTION

To encapsulate these innovations, the team created a new digital platform called “Road Runner” focused on accelerating the APS process.

One platform where all the roles can access, upload and review information. The content displayed responds tp the role specifics (e.g. Insurer, Underwriter, Physician)

Using the platform, the Underwriter sends a digital request for the APS that bypasses the TPA and notifies the client’s physician.

Once the request is receivede by the physician, following a directed digital process, theu complete the APS request much quicker through digital forms.

The Underwriter receives the request back, the information has already been identified and summarized for the underwriting process.

The insurer finishes underwriting the life application and the broker (in turn the customer) is happy to get life insurance coverage in less than two weeks.

ESTIMATED IMPACT

Brings improved data quality through new digital tools.

Introduces a new physician bonus incentive program.

Launches a digital process that reduces cycle times by up to 70%.

Increases profitability for all the stakeholders.

costefficiet

APS Cost

up to 70%
Reduction in costs to request and pricess APS documentation

timesaving

Cycle Time

50% to 95%
increase in the time it takes to complete an APS request

Caseunderwrite

Case Underwriting

100% to 400% increase the number of cases underwritten per day which require an APS

RESULTS

Over 3 months a new underwriting solution was developed with the potential to bring about +$80MM in benefits to the Canadian Life Insurance Industry.

10

Empathy Maps

45

User Interviews

5

Surveys

35

Wireframes

80

MVP Screens

4

Prototype iterations

1

Innovation Report

3

Project Presentations

PARTICIPANTS

We also offer intro sessions that provide insurance professionals with the opportunity to experience our Cookhouse Labs methodology and a sneak peek at what it’s like to co-create and collaborate with our global community. If you are not a Cookhouse Labs member and are interested in finding out more, check out our membership benefits!

Insurance Loyalty & Rewards

Innovation Project Summary Cookhouse Lab

Insurance Loyalty & Rewards

A loyalty program creates a relationship between a consumer and a brand. Companies offer their customers promotions, exclusive products or pricing in return for their loyalty.

12

WEEKS

TORONTO

2017

5

MEMBERS

1

MVP

Problem

Insurers do not know how to show customers that they care about their life, wellness and behavioral changes, therefore they don’t retain them.

Building an insurance customer relationship

WHY?

Insurance companies need customer loyalty otherwise they become a commodity

CUSTOMER

CUSTOMER'S FAMILY

INSURER

REINSURER

DISCOVERY

Nowadays people show a lack of interest in financial products mainly resulting from a limited understanding and awareness.

Connect insurance to daily used appliances via Internet of Things

Create an online environment and communities for users with gamification and social media integration

Collect, analyze and provide data and information

Motivate and reward customers to engage and mitigate risks

SOLUTION

The project team developed a high fidelity minimum viable product (prototype) insurance focused customer caring mobile application nicknamed as “BACON”.

Single place to easily manage your insurance. New communication channel and data sources (IoT) to enable a better understanding of end customers.

A digital experience to engage users through gamification providing challenges that incentivize risk mitigating behavior. Motivate and reward customers for risk mitigating activities.

Loyalty and Rewards platform that focuses on caring. Overall view of customers life and the areas they care about. Place to store all insurance information. Channel of communication with the customer.

ESTIMATED IMPACT

An “everything in one place” experience where customers have all their insurance info in one place organized by care categories rather than products.

Positive behavior driven challenges and rewards to further protect the customer’s insurance care items using daily used IoT-connected appliances.

customerfeed

Customer Engagement

increase
with insurance literacy and a gamification approach for motivation

loyaltyincrease

Customer Loyalty

increase
through a personalized insurance experience rewarding positive behavior challenges

customerdata

Customer Data Collection

increase
allowing a better risk assessment understanding and tailored product offerings

RESULTS

Over 3 months an insurance focused customer caring app was created to attract new and retain existing customers focused on mitigating risk altogether.

6

Empathy Maps

93

User Interviews

67

Surveys

52

Wireframes

160

MVP Screens

7

Prototype iterations

1

Innovation Report

6

Project Presentations

PARTICIPANTS

We also offer intro sessions that provide insurance professionals with the opportunity to experience our Cookhouse Labs methodology and a sneak peek at what it’s like to co-create and collaborate with our global community. If you are not a Cookhouse Labs member and are interested in finding out more, check out our membership benefits!

[SERIES] 500 Days of Innovation – MVP Madness

As we near the 500-day mark for Cookhouse Lab, we thought it would be fitting to take a trip down memory lane. Join us as we explore highlights from our first 500 days in a new blog series titled: 500 Days of Innovation. Each installment will explore a different aspect of Cookhouse Lab that has played a key role in our journey so far. First up is ‘Minimum Viable Product; also known as ‘MVP’.

The Cookhouse Lab experience is centered around an accelerated Minimum Viable Product (MVP) creation journey.  On average, project MVPs have been completed between a two to four week period, which is a combined effort of project teams and Cookhouse Lab design and technical teams. So what exactly is an MVP?

An MVP is the most pared-down version of a product. It has three primary purposes:

  • Provides enough value to illustrate the buyer/end-user potential
  • Offers a practical (and not abstract) demonstration of the benefits and features of the product/service
  • Creates a feedback loop to guide future development or investment 

To give you a better idea, we are sharing five real and noteworthy MVPs that were generated in 2017 in Cookhouse Lab. 

1. Insurance Loyalty & Rewards

The Problem: Twofold. Insurance companies have difficulty retaining customers.  Meanwhile, consumers have a hard time keeping track (and understanding) policy information, creating a negative customer experience.

The MVP: An insurance-focused customer caring mobile application which was named ‘BACON’. 

What makes this MVP stellar?

This app was the output from a 12-week sprint, designed with the end goal of benefiting both the customer and the insurance companies with the following set of features:

  • Centralized platform: This creates a single place to easily manage all of the customer’s insurance. New communication channels and data sources (from IoT) enables a better understanding of customers.
  • Digital experience: This engages users through gamification and would incentivize risk-mitigating behaviour and reward those who do well.
  • Positive association: This platform focuses on caring and elevating the level of customer experience, which creates a more positive association between the customer and the company, and ultimately supports the goal of a deeper relationship between both parties.
  • Opportunity: creating a better relationship between customers and insurers through open lines of communication that will drive improved customer engagement and loyalty.

The Bonus: The usage of IoT increases data collection which allows for better risk assessment and more tailored product offerings.

Sample screenshots of ‘BACON’

>> Read the full management report: Insurance Loyalty & Rewards

2. Delays in APS

The Problem: Due to the lack of motivation, poor quality data, and a strenuous paper process, it can take up to 60 days to receive an Attending Physician Statement (APS) from doctors on life insurance applicants. This is a frustrating experience for the consumer and causes major delays and subsequent impact in issuing life insurance policies. 

The MVP: A high-fidelity mock-up of a centralized platform for all parties involved with the APS process (applicant, broker, insurer, and the physician) to access, upload and review information, which was nicknamed ‘Road Runner’. 

What makes this MVP stellar?

This platform was created with real input from those involved with the process today, including physicians, insurers, and brokers. Focusing on the two main and current pain points of cost and time, this MVP provides opportunity for all stakeholders to benefit in both categories:

  • APS Cost: Through this digital process, data quality can be improved, which could trigger a 70% reduction in costs to request and process APS documentation.
  • Cycle Time: Understanding the time constraints that physicians face, this new digital process along with a physician bonus incentive program could create a 50-95% reduction in completion time for a full APS request. Underwriters would also benefit from easy access to information, and it’s estimated that there could be a 100-400% increase in the number of cases underwritten per day which require an APS. 
Sample UW Dashboard screenshot of ‘Road Runner’

>> Read the full management report here: Delays in APS 

3. Drone Insurance – no history, no data, no coverage?

The Problem: The lack of historical data has made it difficult for insurance companies to create new policies, therefore making it impossible for customers to protect themselves when they fly drones. 

The MVP: A two-pronged approach. The first being a community app that focuses on data gathering and social sharing in an effort to create a credible risk model and rating matrix. The second being a standalone one-size-fits-all insurance product that targets the more professional drone pilot audience. 

What makes this MVP stellar?

These MVPs create three main opportunities for the insurance company, while filling a gap that consumers need:

  • New Data Acquisition: The community app creates the opportunity to harness data from drone pilots through gamification. Underwriters will then have more access to policyholder flight data and behavior.
  • Proper Margins: This new data will also help increase accuracy, which allows for charging proper premiums while allowing for usage-based discount pricing.
  • Reduced Fraud: With the combination of user data and publicly accessible social media data, fraud can be more easily detected.

The Bonus: Drones are just the latest example of a ‘new risk’ that insurance companies can insure. As more new risks pop up, the same principles can be applied as a foundation for a new solution. 

Sample layout of community app

>> Read the full management report here: Drone Insurance – no history, no data, no coverage?

4. The Future of Transportation – Autonomous Vehicles

The Problem: The introduction of AI in vehicles, otherwise known as semi-autonomous cars, is a new product and has a lack of historical data to base new policies off of. This makes it difficult for insurers to determine how they are going to tackle the transition period between human and autonomous driving. 

The MVP: Three different products that will tackle three main issues: lack of data, shifting risk, and the shifting usage of cars. 

What makes this MVP stellar?

This MVP was created during our 12-week sprint with information gathered from over 200 respondents as well as a test-drive in one of the newest semi-autonomous cars at General Motors. The following products were developed as part of a portfolio solution:

  • Discovery and Awareness Portal: Understanding that autonomous vehicles are a newer product that do not necessarily have the best public perception, this portal was created to address the safety concerns of customers by providing a manufacturer agnostic resource where customers are able to learn and experience what it’s like to be in an autonomous vehicle.
  • Adaptive Risk Model: As cars gain more and more autonomous features, this adaptive risk model takes into account the transition period where risk is constantly shifting. 
  • Transportation Short Leasing/UBI Application: Uber is not a fad. Short-lease trips will still be popular as cars become more autonomous. This feature is for customers who don’t yet own a vehicle but require transportation. It allows the customer to short-lease trips in an autonomous vehicle. 

The Bonus: Upon outlining a sustainable business model with these MVPs,  the final valuation of all of these products was found as a whopping $150MM. 

>> Read the full management report here: The Future of Transportation – Autonomous Vehicles

5. Blockchain & Group Benefit Coordination

The Problem: The lack of communication between insurance companies in the group benefit coordination process has created an environment for frequent touchpoints, manual intervention, and the exchange of duplicate information, which has proven to be inefficient and costly. 

The MVP: A blockchain prototype with both customer and company portals that was built with Hyperledger Fabric on Amazon Web Services (AWS). 

What makes this MVP stellar? 

Hyperledger Fabric is a known blockchain framework that was contributed to by Digital Asset and IBM, and allows for various components to be plug-and-play. AWS provides a secure cloud computing service which provides the necessary database storage. The combination of both of these tools will benefit the group benefit process in two major ways:

  • Time efficiency: This new blockchain prototype eliminates the need to submit the same claim multiple times when covered by multiple providers, which will heavily reduce the amount of time and effort required for customers to get their compensation. 
  • Cost efficiency: This prototype will also benefit secondary insurers. With direct information from the primary insurer, claim information can be trusted, which will eliminate the need for back and forth between both parties. 
Sample customer portal, claims history view

>> Read the full management report here: Blockchain & Group Benefit Coordination

These are just some of the MVP highlights from last year, and we’re ready to create more! Our menu has filled up with amazing projects in both the life and P&C space for the first half of 2018. Check them out and join our innovation journey!

Become an industry thought leader. Don’t forget to share.