Claim Assist - Accelerating Claim Verification

The insurance industry grapples with complex operational challenges, including the arduous task of manual document classification and indexing, fragmented and manual claim verification processes, and lack of centralized knowledge management. Insurers find themselves drowning in paperwork, with time-consuming and error-prone scanning, uploading, categorization and verification of customer documents. Reviewers navigate through disparate systems and handwritten forms making it much difficult to process claim in timely fashion affecting their performance.

Our solution offers a powerful answer to the operational challenges faced by the insurance industry, enhancing the arduous process of document classification, indexing and verification of client files with exceptional precision and speed. It seamlessly integrates with insurers' current systems for verification and generating action items for the reviewers. It also provides ‘reviewers mindset’ from claims history (of similar claim category).

This solution is functionally taking care of three personas:

1. Uploader – At onsite – closely working with Mailroom who scan the mail and documents and upload them in system.

2. Verifier - Back office -Validate the claim documents for completeness and accuracy, and fill the regulatory checklist

3. Authorizer: - Back office – Verify and approve claim to ensure Verifier has done everything correctly and authorize payment for next steps.

This Gen AI solution is implemented using AWS native services and LangChain. Below are several of the AWS services leveraged for the overall solution development: Amazon Textract, OpenSearch Serverless (Open Source Search Engine - Amazon OpenSearch Service - AWS), LLM via Amazon Bedrock, AWS Lambda, Application Layer — ReactJS