Prudential’s new e-claims platform to speed up processing time

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(Hot news Today Tuesday 14 November 2017)

Prudential’s new e-claims platform to speed up processing time

AFP file photo.

By Angela Teng

Updated 14 November, 2017

SINGAPORE — Insurance company Prudential Singapore announced plans to start a pilot for clients to make e-claims, touting that the digital platform can process claims “in seconds” instead of the seven days needed now.

The first phase of the trial — set to start late this month and end in the first half of next year — will focus on automating the processing of its PRUshield pre- and post-hospitalisation claims from eight major hospitals: Singapore General Hospital, Tan Tock Seng Hospital, Changi General Hospital, KK Women’s and Children’s Hospital, Alexandra Hospital, Khoo Teck Puat Hospital, Ng Teng Fong General Hospital and National University Hospital.

These claims form the bulk of the 14,000 paper bills and receipts that the company’s claims assessors review each month, it said.

Those applying for claims can upload scanned images of bills and invoices through the portal, significantly reducing the time that its assessors spend handling paper-based submissions.

The insurer intends to fully launch the e-claims platform, if the trial is successful, by the second half of next year.

The system uses artificial intelligence (AI) and an inbuilt text-mining engine identifies and categorises payable and non-payable items. Then, a smart machine-learning engine assesses the validity of the claim and recommends an outcome (approve, partial approve or decline), and the payment amount.

The system has been “trained” and tested using claims data from the last two years. It has reached a good level of accuracy, Prudential said.

The use of machine-based decision systems would also help the claims assessors to focus on more complex claims and higher-value customer initiatives, it added.

Industry observers gave the new technology a “thumbs up,” saying the faster turnaround time would benefit both the insurer and the client. They also said that the technology could have the potential to “revolutionise” the industry.

However, they were also concerned about the potential cutting of jobs with AI doing part of the work.

Ray Alliance Financial Adviser’s managing director Raymond Ng said: “To have a turnaround even within the same day is already a fantastic feat, let alone in seconds. The process will relieve a lot of unnecessary delay.”

However, he is wary about clients “abusing” the e-claims platform by forging the receipts, for example. “I am not certain how intelligent the AI is, to make sure that the claims are not forged, since it uses text-mining. The insurer will need to have such considerations before bringing it into action.”

Mr Eddy Cheong, head of DIYinsurance, said that the streamlined claims process would definitely help clients to quickly alleviate cash-flow problems during a medical event.

He believes that the focus for a start would be on first processing simpler claims, for example, policyholders without any previous medical history. “The claims assessment for pre-existing medical conditions are usually more complex,” he explained.

Responding the the news, insurers Great Eastern and AIA Singapore told TODAY that they have been moving in the same direction.

Great Eastern launched its “robotics process automation” in May for its medical claims. The system reduces the claims processing cycle from two to three days to one day, it said.

AIA said that it has similar initiatives in the works and is developing e-forms for most transactions. The electronic submission of forms would be enabled with straight-through processing capabilities, it added.