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5 Benefits of AI for TPAs to Improve Service and Outcomes in Claims Administration

From using Waze to help you navigate to your doctor’s appointment to depositing a check through your smartphone app, Artificial Intelligence — otherwise known as AI — is already part of our everyday lives. And it’s only the beginning.

According to PwC, 86% of executives say AI will be a “mainstream technology” at their company this year.[1]

In the insurance world, there has been some reluctance to adopt AI. Yet there are tremendous efficiencies to be gained, especially for third-party administrators (TPAs) working to administer insurance and reduce business risk. In fact, TPAs are uniquely positioned to benefit from AI, which works best when it is informed and shaped by a large body of data. We all know the insurance industry has mountains of data at its disposal.

Today, many TPAs are taking on even more responsibility for their customers than before. Technology powered by AI can help TPAs manage this extra workload by promoting operational efficiency and even maximizing customer retention.

Improving the TPA’s operational efficiency

No longer the stuff of science fiction, AI can help a TPA claims adjuster gather information, analyze data by running a model and make data-driven decisions, freeing you up from repetitive, operational tasks in favor of other business-critical endeavors.

Think about how AI can aid claims administration, for example. The manual method of processing claims is complex and tedious, and it involves a lot of paperwork. With this approach, the TPA claims adjuster spends a lot of time gathering information, following a complicated list of steps to process it properly. Without an automated process to validate data, human error is bound to occur when filling out forms manually. With AI software, the TPA claims adjuster can improve efficiency, ensure accuracy and focus on higher-value tasks.

Specifically, the benefits of using AI in claims administration software include:

  1. Fast-track simple claims. AI is revolutionizing claims administration. With predictive outcomes, a low-cost claim can be flagged automatically for straight-through processing, eliminating the need for adjuster intervention, unless a change in the claim requires it.

  2. Apply the best resources. Conversely, AI can help identify costly claims, or even jumper claims, that allow the TPA to apply the best resources possible to improve claim outcomes. In fact, generally speaking, the avoidance of litigation of a single claim can cover the cost of an AI solution. Just think of the possibilities for TPAs to provide ROI to their customers.

  3. Communicate, communicate, communicate. A TPA’s trademark is their ability to communicate successfully. But with a huge number of claimants, clients, vendors and others trying to stay in touch, it would be easy for adjusters to get bogged down in those interactions. TPAs that rely on AI for effective communication, on the other hand, use many methods of initiating contact and responding to queries: interactive voice recognition, email, chatbots and even automated text messages. And when a personalized touch is needed, the claims adjusters and case managers are still there to lend a hand.

  4. Focus on fraud. As in other industries, insurance fraud is becoming more nuanced and sophisticated in recent years. It’s also harder to identify. TPA adjusters may only recognize what they knew historically was a red flag, but ever-evolving practices create greater challenges. With AI, on the other hand, even new forms of fraud can be identified and stopped before it’s too late.

  5. Maximize operational efficiency. Any repetitive task a TPA is responsible for can be automated with AI. What’s more, reducing the adjuster’s effort can lead to greater efficiency overall as well as cost savings related to daily work. With AI, TPA claims adjusters can manage a larger case load. They can also focus on higher claims activities, such as providing personalized service to clients.

Meeting customers where they are

In today’s rapidly evolving insurance market, claims technology powered by AI is proving essential for TPAs and other organizations striving to maximize customer retention and ensure growth. Clients certainly appreciate efficiency and productivity. Your customers, too, have new and evolving expectations today. In partnership with Millennials especially, who are accustomed to on-demand service and instantaneous communication, AI may prove to be essential.

TPAs that rely on AI to help process claims can better focus on outcomes and service, including:

  • Accelerated workflow and improved productivity
  • Tightly integrated data, systems and people
  • Addressing regulatory issues
  • Managing multi-line claims operations, including disability, liability, auto, property and workers’ compensation
  • Obtaining and sharing insights easily with advanced reporting and analytics tools

Next Steps

TPAs leading the industry are already relying on AI to simplify processes, cut costs and better care for customers. Don’t be left behind. Learn more about how AI can help your organization take the first step toward organizational growth.

For more information on using AI as a TPA to help improve service and outcomes, contact LESLIE SARGENT, Ventiv’s TPA practice leader.

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[1]https://www.pwc.com/us/en/services/consulting/library/artificial-intelligence-predictions-2021/no-uncertainty-here.html

Apr 23, 2021

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