Claims Copilot

Solutions

- Ingest claim documents and extract appropriate claim information through the use of knowledge graphs.

- Leverage AI agents to validate and correct data to minimize human review effort.

- Business users manage and configure knowledge graphs without programming

Benefits

- Rapid and accurate ingestion of claim information with documented data lineage.

- Accurate extraction of claims information regardless of format (Acord forms, emails, letters, medical documents, invoices, etc.).

- Ability to incrementally improve and fine-tune knowledge graphs to capture new information as new products and claim types emerge.

Solutions

- Real-time extraction of claim information at first notice of loss.

- Supports multiple inbound sources including email boxes, portals, or transcripts of chat and other communications and outbound connections to claims management systems, such as Guidewire.

- Real-time analysis and scoring of claim information for effective handling and triage decision making.

Benefits

- Rapid capture, analysis and setup of claims files improves customer satisfaction and shortens claims cycle times.

- Intelligent capture of claim information at the time of acquisition improves data capture and accuracy.

- Knowledge graphs help capture essential information and extract additional information, such as witnesses and medical providers that might otherwise require additional claimant communications.

Solutions

- Leverage knowledge graphs and scorecards to confirm claims occurred during the policy period.

- Compare the loss request with core policy information to analyze claim relevance, applicability to insureds and provide adjusters with useful coverage insights

Benefits

- Reduce time required to validate the claim occurred during the policy period to an insured customer and is relevant to the coverages of the policy.

- Eliminate unnecessary payments for non-covered claims.

- Provide clear documentation for claims file and adjuster review 

Solutions

- Leverage and maintain, without coding, professionally designed knowledge graphs and scorecards to rapidly evaluate loss to detect high-severity claims.

Incorporate treatment strategies to improve triage decisions and prepare claims managers
Score claims on FNOL or when claims files are updated with new information.

Maintained by claims business analysts to reduce IT burden.

Benefits

- Early notification of high-cost claims potentially requiring additional resources and special treatment.

- Support triage decisions to consistently apply best practices and handling methods.

- Low cost of maintenance with short update cycles measured in days.

Solutions

- AI-driven knowledge graphs and scorecards referral suspicious claims for investigation.

- Knowledge graphs capture fraud-relevant information and are easily maintained and updated by claims business analysts.

- Scorecards can execute at the time of FNOL and as claims files are updated

Benefits

- Early awareness of potential fraudulent claims can reduce unnecessary claims payments and improve overall profitability.

- Meet the dynamic nature of insurance fraud, with claims managed and easily updated, and fine-tuned fraud detection scorecards.

- Test and deploy changes in days.

Solutions

- Ingest data from legacy systems and perform necessary transformations to support systems conversion.

- Extract structured information from claims documents to enhance claims understanding and analytics.

- Apply Gen AI agents to evaluate claim data accuracy.

- Connections are available to claims management systems, like Guidewire.

Benefits

- Increased accuracy in data conversion leads to better claims analysis and adjusting decisions.

- Extracted data enriches claims files and supports improved claims modeling.

- Claims conversion is accelerated with faster data availability.

Solutions

- Quickly score claims at FNOL and as files are updated for potential subrogation opportunities.

- Relevant data is collected through professionally designed subrogation knowledge graphs and maintained, without code, by claims business analysis.

- Knowledge graphs and scorecards are easily updated and deployed with little technical involvement within days.

Benefits

- Accelerates subrogation activities, with direct reduction of loss ratio.

- Early subrogation actions improve collection of relevant data, inform claims adjusting decisions and increase the likelihood of subrogation collections.

- Easily maintained and updated subrogation knowledge graphs and scorecards support continuous improvement.

Solutions

- Score new claims and updated files to evaluate potential litigation or attorney representation.

- Litigation knowledge graphs and scorecards are professionally developed and maintained, without code, by claims business analysis

Benefits

- Early identification of litigation or attorney involvement creates both time and options for treatment by claims adjusters.

- Case reserves can be adjusted during the early stages of claims, reducing stairstepping.

Solutions

- weav.ai integrates with common claims management systems, like Guidewire, to support real-time and batch interaction.

- weav.ai can create new claims records in claims management systems at FNOL.

- weav.ai can regularly execute claims analysis scorecards, providing fraud, severity, litigation and many more insights for claims files in popular claims management systems.

- weav.ai can automate conversion of claims data and data quality management from legacy systems.

Benefits

- Enhancement of claims management systems with state-of-the-art Gen AI analytic capabilities.

- Accelerated creation of new claims field within popular claims management systems.

- Ongoing analysis of claims using weav.ai’s Gen AI scorecards.