Assi

gnment3(
Heal
thI
nsur
ance)

Submi
tt
edt
o:Mr
.Gaur
avTr
ipat
hi

Submi
tt
edbyAnmol
Chauhan(
1920983013)

Q.1-Consi
deri
ngi nit
ial
inv
estmentandcostofoper
ati
oncust
omercent
ri
cit
yandlong-
ter
m
benefit
ssett
inginhouseoper at
ionsi
sbett
erthanworki
ngwit
hthePAgiv
ey ourv
iewsei
theri
n
favouroragainsttheabovestat
ement?

Ans1Whi
lechoosingaHealthInsur
ancePlan,
thi
sisquit
eani
mpor
tantconsi
der
ati
on-
Thi
rd
Part
yAdmini
str
ator(TPA)orin-
housecl
aimsprocessi
ng?

AThi r
dPar tyAdmi ni
str
ator(commonl yref
erredtoasTPA)i sanIRDA(InsuranceRegul
ator
y
andDev elopmentAut hori
ty)approvedspecializedheal
thcareservi
ceprovi
der.ATPApr ovi
des
theinsurancecompanywi t
hav arietyofservi
cesl i
kenetworki
ngwithhospit
als,ar
rangi
ngfor
cashlesshospital
izat
ionaswel lascl ai
mspr ocessing&timelyset
tl
ement.Theyhelpina
numberofsi tuati
ons,li
ke:

•I
ncasecashlessfacil
i
tyneedst
obeav ai
l
edincaseofpl
annedhospit
ali
zat
ion,
ther
eisapr
e-
approvedfor
mt hatneedstobef
il
ledandappr
ovedbytheTPAatleast48hoursbef
ore
hospit
ali
zati
on.

•I
ncasecashlessf
aci
l
ityneedst
obeavail
edincaseofunpl
annedhospi
tal
i
zati
on,TPAcounter
atthehospi
tal
shel
poutforaspeedypr
e-appr
ovaloft
hesamesothattr
eatmentofthepat
ient
i
snothamper ed

•I
ncaseofr
eimbursement,
theformsalongwiththeor
igi
nal
bil
l
sandpr
escr
ipt
ionsneedt
obe
sentt
otheTPAforfil
i
ngtheclai
m wit
ht hei
nsurer.

Mor eover,
theTPAonl yhelpsthecustomerf ortheclai
mt obef i
nal
lypaidout
.Thus,ther
eare
numer ousr easonswher et heycanbeofhel pt othecustomer s.Theyarebasi
callyconsi
der
ed
ast hedir
ectpoi ntofcont actforthecustomer s.However,newandmuchsmal l
erHealth
InsuranceCompani esdonotr equir
eanout siderThi
rdPar t
yAdmi nist
rat
ortoli
aisonbetween
them andt hecust omersi ncetheyarenewt othisi
ndustryandhasamuchl essercustomer
baset hantheol derinsurancegi ant
s.Thus,theircl
aimsar esettl
edwithi
ntheInsurance
Companyi tselfwi t
houtext ernalhel
p.

TPA’
sov
erI
n-HouseCl
aimsPr
ocessi
ngDepar
tment
:

1.Cont
act
ingt
heTPAisamucheasierj
obwheninemergencybecauset
hereisaTPAatev
ery
networ
khospi
tal
andhencet
heyser
veasthecust
omer’
sonepointofcontact

2.Thephysi
caldeskoft
heTPAandthepersoni
sfoundattheTPAofficerat
hert
hantal
ki
ngt
o
acustomercar
edepartmentasi
nthecaseofI
n-HouseCl
aimsProcessingDepar
tment
I
n-HouseCl
aimsPr
ocessi
ngDepar
tmentov
erTPA:

1.Si
nceev
ery
thi
ngi
sdonei
nhouse,
theTur
nAr
oundTi
me(
TAT)f
orr
esol
vi
ngaquer
yisl
ess

2.Thedeci
sioni
stakenbyt
hem i
nst
eadofsimpl
yli
aisi
ngbet
weent
hei
nsur
erandt
he
cust
omerandhenceagaint
heTATisreduced

3.Ift
hereisanyanomalyint
heclai
m, thesamecanberesolv
edbytheIn-
HouseClai
ms
Processi
ngDepartmenti
tsel
frat
herthansimpl
yli
aisi
ngbetweent
heinsur
erandthecust
omer
asinthecaseofTPAs.

Thus,ifyouactual
lyt
hinkover,
beitTPAorbei tIn-
HouseClaimsPr ocessi
ngDepar
tment,
which
shouldnotbethedecidingfact
orforopt
ingforanyhealt
hinsuranceplan.Bot
harequi
te
eff
ectiveincl
aim set
tl
ementintheirownspheres.Thus,
youneedt ochooseaplanaccor
dingto
yourneedsandt hensettl
efort
hesame, i
rr
espectiveoft
hefactwhet heri
thasaTPAforclai
m
sett
lementorIn-HouseClaimsProcessi
ngDepar t
ment.

Q2.Resear
cht
hreest
art
-upswhopr
ovi
deAIorMLsol
uti
onsi
nunder
wri
ti
ngorcl
aim ar
ea?

Ans2.Herear
emanyf i
ntechstartupsusi
ngAItoinnovat
eandst r
eamli
nethedail
yprocesses
andcreateal
gorit
hmsi nordertost r
engt
henthei
rdataanaly
ticsanddeci
sion-
making
capabil
i
tiesi
ninsurancesector.Threeoft
hem ar
easf ol
lows

Fl
exi
l
oans

Thest artupi swor kingoncut ti

ng-edget echnol ogiesandal gor i
thmst ocr eateaf ul
ly-
automat ed
l
endi ngpl atfor
m ov eranAPIi nfrastruct ure.It
sAIcapabi li
ti
esr angefrom i mager ecogniti
onand
OCRt oaut omat edonboar ding,anomal ydet ection,identif
yingf r
audsandel i
minat i
nghuman
bias.Thisf acil
i
tatesi ncr easedconv ersionsandi mpr ovedcol lecti
onsef f
iciency,deeplearningto
anal y
sespeech, conv er sationalintell
igencei nchat botsusingNLP, andscor ecardst oextract
valueandr educer iskatev eryst epoft hepr ocess.Fur ther,it
sDeepLear ni ngandTechnol ogy
Appl i
cati
ons( DELTA)l abut ili
sesal t
er nat i
vesour cesofdat a,deeplearningnet works,and
adv ancedt echnologi est oi mprov elendi ngpr ocesses. Someofi tsnear-f
ut ur
er esearchincludes
aim attheusageofAR- VR, drones, andf acialexpressionst odel i
versuperhi ghef f
ici
encyand
under st
anduserbehav iourt odet erminer i
sk.

RenewBuy

RenewBuyl everagesopensour cetechnologiestobuildrobusty etagi

lesystems.It
s
i
nf r
astr
uctureisbackedbycl oudcomput ingandscal abil
it
yiskeptatt hecentreofall
its
technol
ogydeci sions.Throughacost -
eff
ici
ent,customer-centr
icmodel ,i
thascreateda
propri
etar
yend- to-enddigi
talinsuranceplatf
orm anddi gi
ti
sedt heenti
r ei
nsurancevalue
chain.
AItoolshel pRenewBuyi ndatacoll
ecti
on, f
iguri
ngoutt heper mutat
ionsandcombi nat
ions
fori
nsurancepremiums,anduseofdat aanal
yti
cstohelpcompani
escr
eatesmartunder
wri
ting
rul
es.I
talsoall
owsbanksandot herpr
ovi
derstoco-
createpr
oduct
swit
hinsur
ancecompanies
backedbyr i
chdataandanaly
tics.

Theenti
repr ocessofpoli
cyissuanceandrenewalsisautomat ed.Ital
sousesAIf orpar tnerand
cust
omerser vici
ngli
keendor sementsandquotegener at
ion,
co- cr
eati
onofpr oducts,pre-sal
es,
post
-sal
esandcust omerser viceusi
ngbots.
Theself-
inspecti
ont oolwithi
nitsappintegrates
wit
hinsurer
s’ under
writ
inglogicengi
neandusesAIt oappr oveorr ej
ectthecaseinr eal
-time.
Forpost-
sales,non-
fi
nanciali
mpl i
cati
onsunderwri
ti
ngar eautomat ed,whichprovi
des
i
mmedi atesoluti
onstocustomer swithr
egardstopolicyservi
cingandcl ai
mspr ocessing.

CapeAnal
yti
cs

CapeAnal yti
csof fersaser v i
cewhi cht heycl ai
m canhel ppr opertyinsur ersunder writemor e
accur atelyandmor ecost -
ef f
ect i
velyusi ngsat elli
te-basedmachi nev ision. CapeAnal yticscl ai
ms
i
nsur er scanpr ov i
det hecompanywi thanaddr ess.Then, CapeAnal y ti
cs’ sof t
war euses
machi nev isi
ontoanal yzesat elli
teimagesoft hepr oper t
yatt headdr ess. Thesy stem t hen
seemst opr ovi
det hei nsur erwi thal i
stofaspect soft hepr opertythatmaybeofi nter estto
them, suchasdet ail
saboutr oof i
ng; detail
saboutanyexi sti
ngpool ,includi nghowi t’sencl osed
andi fithasadi vingboar d; tr
eesont hepr oper tythatmaybepr onet of allingorcat chi ngonf i
re;
orwhet herornott hepr oper t
yhasat r
ampol i
neoni t.
Thi scoul dprov idet hei nsurerwi t han
accur atei nspecti
onoft hepr oper tywi thoutr equir
ingt hehi r
ingofanact ual humani nspect or
thatshowsupatt hepr oper ty.Li
kelyduet othenat ur eoft hesof tware, wewer eunabl et ofind
anydemonst r
ati
onv ideosf orhowt hesof twarewor ks.Thecompany ’
swebsi t
eonl ypr ovi
desa
mar ket i
ngv i
deo.CapeAnal yticsdoesnotpr ovideanyr obustcasest udi esoni tswebsi te,but
somecasest udi
est outingt hecompany ’
ssuccessar epr ovidedbyOxbowPar t
ners.Thesecase
studiesar eshortandl ackdet ail,
andsowesuggestr eader sbecaut iousaboutaccept ingtheir
claims. Forexampl e,CapeAnal yt
icscl aimst ohav ehel pedanunnamedr egi onalUSi nsur er
reducedi nspectionspendby50per centwhi leusingCapeAnal yti
cs.I not herwor ds,t he
companywasabl etopar ti
al l
yf orgohi r
inginspect orst oshowupatpr oper t i
esandv er i
fythe
existenceofaspect soft hepr oper tyt hatwoul daf fectt heunder wr i
tingdeci sion.

Q3.Whatarethebi
gcust
omer
sconcer
nsr
elat
edt
ocl
aim set
tl
ementandwhatar
ethebest
sol
uti
onstoresol
vei
t?

Ans3.Thr
oughoutt
hecustomerjour
ney ,i
nsur
ersmustadaptt
otheuni
queneedsofeach
consumertoprovi
dethebestexper
ienceandearnl
oyalcust
omerswhowil
lserv
easimport
ant
ambassadorsforyourcompanyint
hef ut
ure.

ACTI
VELYCOMMUNI
CATEDURI
NGTHECONSULTATI
ONPHASE

I
nsuranceisn’tanicet
ohave,andconsumer sseekoutcoverageoutofnecessit
yrat
herthan
desi
re.Changesinsomeone’spersonalsi
tuati
ontri
ggerconsumerstoentertheconsult
ati
on
phaseandst artr
equest
ingi
nformati
onfrom insur
ers.I
nst
eadofinsurer
slookingtocreate
demand, customercommuni cat
ioninlargepar tonlybegi nswhent heneedi salreadyacute.
Tradi
ti
onally,i
nteracti
onsbet weeninsurersandcust omer sar e“accident
-driven”insteadof
beingi
niti
atedbyi nsurancecompani es.So, howdoy oupr oact i
velyimprovet hecust omer
experi
ence?Manyi nsurancecompani esaref aili
ngt oactivel ypromot enewpr oductsorservi
ces
tocustomers.Tooof t
encust omerinteracti
onsar ebasedonneedandwi thoutcause, occur
ri
ng
haphazardly
.Global l
y,44%ofcust omer shav ehadnoi nteract i
onswi ththeirinsurersinthel
ast
18mont hs.Insteadofbei ngpassiveinther elati
onshi pandr ely
ingoncust omer st o
communi cate,i
nsur er
sshoul dtakemor econt rolandowner shipbymaki ngt heircustomers
awareofcompr ehensiverisksandtheneedt opr otectagai nstthem.

PERSONALI
ZEACROSSCHANNELSI
NTHEPURCHASEDECI
SIONPHASE

Ascust omer sent ert hepur chasedeci sionphase, thecust omerexper iencebecomesev enmor e
i
nt egraltot herelationshi p.Wi tht hegr owthofdi gitalchannel s,therear esev eralopt i
onsf ora
cust omert opur chaseapol icy ,suchasper sonal sales,ani ntermedi ar y,yourwebsi teor
compar isonpor tals.Wi th80%ofcust omer swi l
li
ngt ousedi gitalandr emot echannel optionst o
compl et et asksandt ransactions, i
tiscr iti
cal t
omeetcust omer sondi versechannel switha
highlyper sonal izedappr oachr egar dlessoft hepur chasepl atform.Cust omer spl aceahi ghv alue
onaneasypr ocessandi ndi vidual izedopt ionsandwantt obuyf rom insur ancecompani est hat
ser veupcompr ehensi vepol icyi nf ormat iont hatistail
or edt ot heirspeci f
icsituation.Acrossal l
pur chaseopt ions, thehumanf act or( orper sonal contact )isacr ucial componentofconv erti
nga
prospecti ntoacust omer .Per sonal consul tati
onsst i
llremai nimpor t
ant ,butconsumer snow
al
soexpectt oqui ckl yreachy out hroughi ntermediaries, ser vi
cecent ersordi gi
tal channels.To
offerbot hdet ai
ledandper sonal izedcommuni cations,insur ancecompani esneedt ooffer
per sonal consul tationser vicest hatar esuppor t
edbyot herchannel st ocommuni catethev alue
ofpr oduct sandser v i
ces.

BALANCEHUMANSANDTECHNOLOGYDURI
NGTHESUPPORTANDSERVI
CEPHASES

Whencust omer sreachoutf orsuppor t,theywantt heexper i

encet obet hreet hi
ngs: per sonal ,
fastandeasy .Tofulfi
l t
hisexpect ation,insurersmusti ntegr atetrusted,fami l
iarcont act
channel swithdigit
al options.Whi l
ecust omer ssti
llwantqui ckandst r
ess-freeaccesst of riendly
andaccommodat ingi nsurersov ert hephone, ther
ei sal soadesi retocommuni cat ev i
adi gital
cont actopti
onsl i
keemai l,chatandev enself-serv
ice.Forcust omer s,bothanal oganddi gi
t al
channel sareequal l
yimpor tancewhent heyar elookingf ori nsurancesuppor t
.Whensubmi tti
ng
acl aim,customersal sowantaseaml ess, r
apidandi ndividualizedpr ocess.Dur ingt heser v i
ce
phase, speedbecomesal argerpr i
or i
tydur i
ngcl ai
m set tlement sandpay mentpr ocessing.
Despi tetheimmedi acyofdi gitalserv i
ces,thesesol utionsar eof t
enunder -
util
izedi nthisar ea.
Althoughcust omer sar eusedt olev eragingtheser vicecent erfordi r
ectexchangeswi thinsur er
s,
digitalandmobi l
epr ocessi ngcani ncreaseef fici
encybysol vingcl ai
msqui cklyandpr oviding
trackingforcustomer s, dri
v i
ngi mpr ovement si ncust omersat i
sfaction.