Case study

Improve claim resolution process using Gen AI

Amplify Analytix developed an internal chatbot that helped a healthcare insurance company optimise claim letter generation

60-70% LESS TIME SPENT ON RESOLVING CLAIMS

7% REDUCTION IN COSTS

5% DROP IN ERROR RATE OF CLAIM LETTERS' CONTENT

5% DECREASE IN EMPLOYEE ATTRITION RATE

The Business Challenge

Upon receiving claims for outstanding payment completion, a health insurance company uses a rule-based expert system to respond to the appeals sent by the healthcare service providers, resulting in back-and-forth exchange of letters. Historically, about 70% of the responses by the rule-based system led to appeals, resulting in unrealised cost.

Improve claim resolution process using Gen AI 1

The Solution

Amplify Analytix developed an assistant powered by Generative AI that allows insurance agents to treat claims efficiently and reliably. The assistant was fine-tuned on historical data from specific patient cases leading to the generation of semantically and syntactically accurate responses. Thanks to the improved accuracy of the content quality, the Gen AI assistant reduced the risk of back-and-forth letter exchanges, which led to a reduction of unnecessary costs and human efforts. The approach empowers insurance teams to create impactful letters ultimately leading to a decrease in unrealized revenue loss.

Improve claim resolution process using Gen AI 2

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