Perceptiviti: Automating Claim Processing using Artificial Intelligence based Platform

Insurers are under increasing pressure to reduce response time on claims. At the same time, insurance fraudsters are constantly finding new methods of defrauding the insurers and their members alike. There is urgency to solve this problem.

While the experience of claims handlers will remain important, AI can help quickly and continuously look for fraudulent patterns in a very detailed manner. AI applied to fraud allows an insurance carrier to more effectively, efficiently, and speedily detect fraud compared to traditional manual intensive methods. Using advanced technologies, harnessing big data, and employing network graph analytics along with machine learning techniques creates a powerful approach to detect fraud and helps address many of the challenges faced by insurance companies. New Delhi based Perceptiviti has built an AI based fraud detection platform that helps insurance companies save millions of dollars. “We have designed a state-of-theart platform that focuses on Fraud and Risk Management in Insurance, Financial Services and Online”, says Sandeep Khurana, Founder, Perceptiviti.

End to End Claim Process Automation on Sherlock

The company has a very advanced platform that looks into hundreds of data points, both, the company owned and external third party data. Based on this, Perceptiviti identifies patterns towards inaccuracy in claims that human observers often miss. The platform processes thousands of claims and gives the intelligence in real time, with subsecond response time. Perceptiviti's flagship product, Sherlock was created after intense research, combining years of expertise in fighting Fraud in various industries across the world, using technology, field research and various analytical methods.

This AI powered SaaS platform automates claims processing and significantly cuts down the processing time from several hours to a few minutes. With significantly proven and improved fraud prevention methods, Sherlock has achieved over 90 percent accuracy rate for certain datasets.

In a short period of one year Sherlock has been deployed in enterprises to fight fraud and the platform is delivering outstanding results to enterprise customers. The platform continues to be enriched with newer datasets, skills and advances in AI algorithms. Offered through software as a service model, it can be quickly and easily integrated with the claim management system which can start giving results in matter of days. Perceptiviti’s Sherlock platform offers a secure, reliable, and scalable infrastructure that provides a simple RESTful API based integration point to ensure the sharing of critical data to and from any source system. Moreover, Sherlock’s Adaptive Rules provide additional flexibility to businesses by allowing clients’ Fraud Analysts to explicitly define rules to catch emerging fraud scenarios. As a cognitive platform built grounds up for detecting fraud, it helps reduce cost of Fraud Detection by over 70 percent. Sherlock, frees up time of clients’ most skilled resources to focus on complex cases, leaving day-to-day to Sherlock.

Perceptiviti has essentially automated the entire claim process. Once the system receives the claim form, it segregates the claim form into various sub components, captures the data, identifies the disease or diagnosis and eventually evaluates the payment to be done for the claim without any human intervention. Perceptiviti has worked with a good number of insurance companies and helps process 40,000 claims per month that represents over INR 300 Crores in medical spend every month. Therefore, the companies deploying Perceptiviti’s platform have saved significant capital. This excellence was mainly driven by the experienced team of industry veterans. Perceptiviti’s core and extended teams comprise Data Scientists, Machine Learning experts, Data Management gurus, Domain Experts, Software Architects and Engineers with Multiple accolades and year of experience in their respective area of expertise.

Perceptiviti’s platform is an end-to-end offering that performs intelligent process automation of the entire claim system. More so, at the end of this process, the company also generates a number of insights and visualizations to help senior management understand what is happening in claim book of business. Right from underwriting to claim processing, the data points throughout the entire life cycle of the insurance company are taken into account by the platform. Perceptiviti further intends to bring in OCR, ICR, and Robotics Process Automation to deliver more benefits to the customer and bring in greater visibility to the claim process for the insurance industry at large.