Claims Management Demo

In today's world, we all need insurance. Be that life, medical, homeowners or auto.

Insurance is a service we all need to work with. So dealing with our insurers

shouldn't be a painful experience but sometimes it is. Consider what happens

when you have an auto accident. This already stressful time is made even

worse by the fact that you need to record all sorts of information, fill in

numerous forms and then wait weeks to settle your claim. Well it doesn't have

to be like that. This demonstration highlights how the use of a Nuxeo

Content Services Platform can change the way we deal with insurance claims

forever this brief demo very quickly shows some of the simple but effective

ways in which technology can be used to make a difference.

It shows the art of the possible.

Jane has just been involved in an accident.

she's exchanged information with the other driver and now connects with her

insurance company through their mobile app. Jane is delighted to be

instantaneously connected to a digital claims attendant. At first insured she's

not injured and then guides her through the action she needs to take next

Jane responds quickly and begins a simple yet very effective conversation

where she shares the details of the accident the insurer confirms the

accident location, whether the police are required, if she requires a tow truck,

if she requires a rental car and more... As the police and tow truck arrived Jane

instantly feels reassured and after following the advice of the insurer to

take the photos of the accident she has taken to the repair facility where her

rental car is waiting. When she arrives back home she finds she's received an

email from the insurer providing her with access to her personal insurance

portal and requesting more information.

Jane logs in takes a look through the information in the claim and upload some

more images of the accident and a dashcam video that one of the witnesses

to the accident kindly shared with her.

Jane finishes the uploads and leaves the system. Almost immediately

Jane receives another email asking for her driver's license which she promptly


In what seems like no time at all Jane receives status updates each time her

claim progresses through the process then a notification that her claim is

settled. Funds have automatically been transferred to her account or paid

directly to the service providers and a final notification that her claim is now closed.

A simple painless and automated process that kept Jane informed all the

way through. Not at all like she thought it was going

to be from the customer point of view the entire process from submitting the

claim to adding additional information to actually getting paid was a simple

pain-free process. What happens behind the scenes to make that process go so

smoothly let's view the process from the perspective of Julie, who works for

Jane's insurer Acme insurance. Upon receiving Jane's first notice of loss

the system automatically determines that Julie is the next best available

adjuster to handle the claim. Julie is informed that she now has a new claim to

work on via email. She logs into her claim system and begins to process the

claim. After looking at the various information associated with a claim she

realizes that she needs more information from the claimant specifically her

driver's license. Julie opens the relevant additional

information section and requests the driver's license from the claimant.

Once that information is received Julie can see the image of the driver's license as

well as the information that has automatically been extracted from the

license and any messages that have been sent by the claimant.

Not all claimants are as pleasant and happy as Jane. So the system helps Julie

identify any unhappy claimants by performing sentiment analysis on

incoming messages this allows Julie to quickly identify unhappy claimants and

respond quickly to their concerns once Julie is happy that she has all the

information needed to process the claim she submits the claim to the process

queue for management review and next steps, such as scheduling investigations.

She then moves on to her next claim to manage. Julie has now collected all the

information and required documentation all investigations have concluded she's

created the required reports and she's negotiated the estimated repairs by

collaborating on the damaged photographs with a repair facility. Since the value

of the claim falls within her authorization limits all she needs to do

now is approve the claim for payment. Julie approves and closes the claim.

Once the claim has been approved the final step in the process is to make sure that

the claim is stored accordingly as a corporate record and kept for the

appropriate amount of time. This is done through a very simple process that can

be automated if required and that is the claim process not a lot harder behind

the scenes to manage the claim. What happens when the claim is not so

straightforward? Well not all claimants are as genuine as

Jane. Fraudulent claims cost insurers billions of dollars per year.

Using a combination of artificial intelligence and human intuition, fraud detection

comes to life within the system. In this instance it turns out that two policies

are actually registered against the same license plate one to Jane but one to a

guy will call Bob Bad. It appears that Bob has had multiple claims in a short

period of time and really needs to be looked into in more detail.

The semi-automated detection of potential fraud can be a significant boost to how

effectively the insurance company manages its claims and can be

incorporated into detailed management dashboards and

allow the business to track activity, identify process bottlenecks and

increase visibility into the claims management environment overall.

This short demonstration has looked at the claims process from multiple

perspectives including the claimant, the claims handler and the claims investigator.

All three perspectives have made use of new technology from mobile

capture to AI enabled fraud detection to advanced analytics and even more as

possible with the Nuxeo Platform. This snapshot into the art of the possible is

not the end of the conversation, it's the beginning.