Case study

Advance Care

Industry

Insurance

Automaise Product

Smart Decision

About the client

Advance Care is part of Generali Group which is present in more than 50 countries, with 71,000 employees and 61 million customers. Our client is an health insurance provider that manages a network of medical services and solutions and in the last decade dedicated to create complementary insurance health products available online.

Challenge

The Pre-Approval of medical claims is a process in which a team of paramedics analyses a broad set of medical & technical data to approve/reject the coverage of each medical intervention, driving the cost per decision north of €30 per process/intervention. This approach was costly and subject to delays so Advance Care challenged Automaise to use cognitive automation to solve for this operational bottleneck.

Solution

Using a historical dataset, Automaise created a cognitive automation that was able to mimic the decisions of paramedics and automate the approval of medical claims. A classical data science approach would have required 9-12 months, yet this quick turnaround was achieved through Automaise's proprietary platform - which leverages AutoML, Data augmentation and Learning techniques. Automaise was able to mimic human behaviour with over 98% precision.

Results

60% of medical claims are now fully automated, allowing the insurance company to process claims more efficiently and policyholders to obtain faster responses.
The level of automation is steadily increasing as more data is processed, allowing the insurance company to dedicate more resources to highly complex cases, and offer customers a more satisfying experience.

Main achievements

  • 60% global automation rate of all medical insurance claims
  • 9x improvement in claim processing efficiency
  • Results achieved in 4 weeks