Claim Investigation Model for Savings Policies Qorus Innovation in Insurance Awards 2023

Claims are the moment of truth for life insurers. It is a time when insurers fulfill the promise of the policy to the policyholder and their family. After facing a loss, customers need handholding, assistance and a claims process that is quick and easy. It translates to a claims experience that is digital, simple with fast resolution. While we have already taken various initiatives to make the claims experience a seamless one, providing a faster claims resolution was a key priority. To do that, we have leveraged a proprietary ML-based claims investigation model, which helps us identify claims that are high-risk and need to be investigated in more detail. Before the implementation of this model, 100% of claims (savings plan) received were investigated, which led to higher costs, more effort and a delay in the processing of claims. Implementation of this model helps us smartly tag claims as Red, Amber, and Green, based on the probability of the case being repudiated or rejected. This helps in focused efforts toward investigating claims and increases productivity while enhancing the claims experience for the nominee or policyholder.