Personal Accidental Claims & Investigation Audit Automation Case Study for SBI General Insurance by Artivatic

Use Case & Objective

The solution needed to help in enabling claims team to faster asses the intimation data, documents reading & processing, data match among multiple documents, building investigation audit for conducting investigation and providing final claims assessment with adding multiple processes and rules already available with SBI General Insurance. The idea was to digitally enhance the PA process for reducing time, assessing better, building more AI Based risk /fraud triggers and reducing processing cost.

About SBI General Insurance

SBI General Insurance is a joint venture general insurance company between State Bank of India (SBI), the largest state-owned banking and financial services company in India and Insurance Australia Group, a Sydney based multinational insurance company. SBI owns 70 per cent of the total capital and IAG 26 per cent of the capital. Other investors are Axis Bank Asset Management Co. Ltd and Premji Invest, holding 4% of the total capital.

The company offers a wide range of insurance products and services, in the retail and commercial space.Its offerings include personal accident, home, health, travel and motor insurance in the retail space and aviation, marine, fire, liability insurance, engineering and construction in the commercial space.

Key Challenges & Issues for Personal Accidental Claims

  • >95% Manual Process

  • >20-90 Days Turnaround time

  • <10% Data Driven Insights

  • Error-prone insights

  • No Scoring, no risks, no profiling

  • Legacy process and too many systems

  • Manual video or image based inspection

  • 100% Surveyor dependent claims process

  • Bad customer experience

  • Increase in fraud cases

  • Investigation documents reading and analysis manual

Artivatic's Approach

Process Flow by

Solutions provided by Artivatic to meet SBI GIC Personal Accidental Claims requirements:

  • Historical Learning based in-depth trigger analysis for risk & fraud activities

  • Document digitization for quick claims processing

  • Document data match with internal and external environment

  • Using 3rd party or external data like news, FIR, google map, trends, risks, social, historical, triggers, matching etc. provide audit for claims intimation assessment for investigation need

  • Document extraction & Matching for possible key triggers and authenticity check

  • QC process, Audit process in bulk claims check

  • Provided system for probability of claims investigation need based on multiple data attributes

  • Reasons based on Machine Learning approaches was provided for each claim’s investigation need

Product Screenshot for Personal Accidental Claims

Activities /SolutionsOutcome/AccuracyIntimation Based Investigation73.7% Improvement Document Based Extraction: KYC, FIR, Post-mortem, Investigation, Death Certificate etc.70-85% After Documents Investigation75% [Reasons, Predictions Provided]After Investigation Final Claim AuditPredictions, Risk, Triggers, Matching, External data Points, extraction using AI & ML.Fraud & Risk Insights80%, Added 40% More triggers/dataTime for Claims by Artivatic System15 Mins [Excluding time for Investigation/Document collect]

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