30/03/2023 Insurance Innovation


The happy way to process your claim. End-to-end automation of communication, processing and settlement, like never before: all it takes is one interaction, without human intervention in less than three minutes.

Innovation presentation

Reporting claims to the insurer is often a complicated process for users and they almost always seem to take longer than expected to sort out. After reporting the claim, customers say that they find it difficult to complete the various steps of the process, that the amount of information required is sometimes overwhelming, and that they are unsure how everything will turn out in the end. In fact, negative claims experiences are the main reason customers switch carrier. From the company’s point of view, the situation isn’t much better: processing claims is time-consuming and resource-intensive. Human involvement is required, even in the simplest of cases, and more so when an adjuster needs to inspect and verify the damage in person.

Aimed at customers and brokers, Esencia offers a comprehensive solution for intelligent claims automation based on AI. It interprets the user's natural language and analyzes the documentation, images and other types of structured and unstructured data required for processing. All the information is processed in real time and used by the Artificial Intelligence (AI) models to decide the most appropriate way to process the claim in each case and get back to the customer with a quick response based on objective criteria.

The result is end-to-end claim automation. A single interaction, without human intervention, is all that’s needed, and everything in less than three minutes.

The first version of Esencia has been piloted in Brazil, in the Home Insurance business line (residential), for broken windows and other glass, as well as sanitary ware. The project, which will be scalable to other countries and processes in the future, contributes to MAPFRE’s objective of leading a transformation build on the radical improvement of the customer experience both in current products and services and through the development of new ones that add value to requests that increasingly require greater personalization, ever-better quality levels and a clear focus on customer relationships based on proximity and trust.

Uniqueness of the project

Automating a claim end-to-end is very complex and making it happen in a single interaction, without human intervention and in less than three minutes is something very few insurance carriers can pull off. MAPFRE isn’t just any old insurance carrier thoughand has made it a reality. In collaboration with the selected partner, the insurer has provided its customers and brokers with a comprehensive solution that combines all the necessary elements to enable a customer to get their claim sorted from start to finish (including settlement), quickly and easily. To do so, it has used the following elements:

- A claim communication interface by means of a conversational chatbot that requests and analyzes the information, documents and photos provided in real time.

- Online monitoring of the processing for cases in which the customer needs more than one interaction.

- AI capabilities for natural language processing, document analysis, image validation and real-time decision modeling.

Benefits for the customer:

Speed: immediate resolution with no waiting time, settlement included.

Availability: 24/7 availability.

Customer experience: conversational chatbot in real time.

Reliability (at least equal to human).

Benefits for the insurer:

Improved operational efficiency: reduction of FTEs and outsourcing costs.

Making life easier for intermediaries dealing with the company’s claims, which in turn makes them prefer to work with MAPFRE, which enhances service levels.

Building customer loyalty by radically transforming the customer experience.

Freeing up brokers, managers and analysts from tedious and frustrating administrative tasks so they can focus on more value-adding ones.

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