SmartClaims LISA Qorus-NTT DATA Innovation in Insurance Awards 2026
Submitted by
Zurich Insurance
Zurich is a leading multi-line insurer serving people and businesses in more than 200 countries and territories. Founded 150 years ago, Zurich is transforming insurance. In addition to providing insurance protection, Zurich is increasingly offering prevention services such as those that promote wellbeing and enhance climate resilience.
ChileCategory
Operations & Workforce ExcellenceKeyword
Transformation, Claims management, Automated InspectionBusiness Line
Employee Benefits, Health InsuranceDistribution Channel
Partners
Innovation presentation
What is the innovation?
SmartClaims LISA is a modular claims automation platform that combines (1) GenAI/model-agnostic AI agents for document understanding and classification (LISai) and (2) a no-code business rules/decisioning engine (LISux) that applies insurer‑specific logic, thresholds and exception handling. Together, they enable straight‑through processing while keeping decisions controllable and auditable through explicit business rules.
What does it do (end‑to‑end)?
It orchestrates the full claims process: intake → classification → data extraction → analysis → assessment → settlement, routing exceptions to human review when business thresholds or policy rules require it.
Objectives (why we built it)
• Reduce settlement time drastically and sustainably (From 5 days to average 10‑minute settlement for eligible claims).
• Increase STP and scalability (65% STP by end of 2025; target 85% by end of 2026).
• Reduce health claims handling expenses with evidenced impact (35% reduction in Chile Health).
• Improve customer experience (NPS +30% in 2025).
• Strengthen fraud prevention (USD 50k confirmed prevented in 2025; expanded capabilities in 2026).
Competition / state of the market
Many claims automation solutions focus on point capabilities (OCR and rules) or require long implementation cycles and significant custom coding. SmartClaims LISA differentiates by combining GenAI‑driven understanding with a no‑code deterministic decision layer, enabling faster rollouts and scalable reuse across lines of business.
Inspiration and teams involved
Driven by high claim volumes and the need to improve customer outcomes and operational resilience. Delivered through close collaboration across Claims Operations, Business Leadership, IT and Innovation, with LISA startup as a technology partner.
Current status and roadmap
Live in Chile and Japan in 2024, scaling to additional products: hospital cash benefits, unemployment, SOAP and individual life; planned deployment to Motor and Property by year‑end. Fraud capabilities expand in 2026 with predictive AI and behavioral pattern detection. LISA has just finalized a pilot with our Joint Venture Santander for Motor claims with strong validation results (77% key points were validated and 22% validated with minor observations). Next phase will be in the Life business.
Interested in learning more?
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