Partners

Industry challenge

Litigation and Severity costs are eating into Insurers’ profits and ability to grow. Annually more than 20% of premiums are lost to litigation, fraud and compliance related claims handling. Lack of risk insights also blinds risk selection. Prioritizing claims with high propensity of litigation and severity to reduce claims cycle time and costs while efficiently managing reserves is much needed. Predictive analytics and Insights driven decision are the need of the hour.

The solution

Charlee.ai is an artificial intelligence based predictive analytics patented solution that helps reduce litigation and severity expenses while efficiently reserving claims. Charlee helps prioritize claims with high risks such as litigation, suspected fraud and non-compliance along with deep claim insights to help operational team streamline their workflows. Charlee is a secure, cloud-based and SOC 2 compliant web-application with custom dashboards and KPIs providing easy upload of data via SFTP or APIs.

Business benefits

• Charlee leverages our patented and proprietary natural language processing (NLP) and machine learning models to extract deep insights from structured and unstructured data and predict litigation and severity
• Charlee predicts litigation and attorney involvement starting at first notice of loss (FNOL) and 90-120 days prior, enabling workflow prioritization
• Charlee predicts severity in various ranges (low, medium and high with dollar amounts dependent on machine learning) allowing for fast tracking and insights-based assignments
• Charlee provides claim level alerts and red flags based on deep learning of unstructured and structured claims and policy data for developing investigation action plans
• Charlee provides claims and risk portfolio including operational metrics, reserving patterns and high-risk trends correlating to NLP based tagged topics

Industry challenge

Because speed and convenience have altogether redefined what it means to serve consumers, it is time to start building the relationships your customers demand and deserve. However, you cannot simply accept all policy requests or pay out each and every claim. At least not right away. You have to do your research and you have to do it instantaneously. What would your processes look like if you could instantly trust your customers?

The solution

Knowing when to trust keeps you in control of your processes – automating as much as possible, while engaging staff in case a further assessment is required. In claims processes, FRISS’s Trust Automation Platform automatically notifies your adjusters which claims to trust and which ones require a deeper expert review to scout for fraud. This improves the experience for the sincere customer, while at the same time fraud risks are identified. This all happens in real-time within IDITSuite using a combination of real-time internal and external data, powerful AI models, network analytics, expert knowledge, text mining, and more.

Business benefits

• Direct bottom line savings
• Real-time claims segmentation enables a frictionless customer experience
• Actionable claim insights
• Instant value, reducing the total cost of ownership

Industry challenge

Insurers relying on traditional approaches for underwriting and claims management lack full visibility into risk, which limits their ability to win more business while maintaining their loss ratios.
On the underwriting side, they are challenged with pricing accurately to reflect the risk, limiting their ability to price competitively, quote business quickly, and expand into new markets profitably.
In claims management, insurers lack visibility into claims risks, leading to potentially long-duration claims which can become catastrophic and costly.

With a more complete, in-depth picture of risk, underwriters can make pricing decisions more accurately and more competitively, enabling them to win more business, grow with new clients, and enter new markets profitably. Claims managers gain an “early warning” of the most expensive claims, to focus proactively where needed while reducing the cost of claims. By using Gradient AI’s solutions, insurers of all types achieve a better return on risk.

The solution

Gradient AI is the leading provider of proven artificial intelligence (AI) solutions for the insurance industry. Its solutions improve loss ratios and profitability by predicting underwriting and claims risks with greater accuracy, as well as reducing quote turnaround times and claims expenses through intelligent automation. Unlike other solutions that use a limited claims and underwriting dataset, Gradient’s software-as-a-service (SaaS) platform leverages a vast dataset comprised of tens of millions of policies and claims. It also incorporates numerous other features including economic, health, geographic, and demographic information, as well as modeling expertise and deep insurance industry experience. Customers include some of the most recognized insurance carriers, MGAs, MGUs, TPAs, risk pools, PEOs, and large self-insureds across all major lines of insurance.

Business benefits

• Augmented intelligence to make your organization and people even more effective
• Cutting edge artificial intelligence and machine learning solutions
• Designed specifically for the insurance industry and risk management professionals
• Predictive and prescriptive analytics
• Enable automation and provide decision support

Industry challenge

Reinsurers face the challenge of identifying and financially quantifying cyber risk for a single business and accumulated exposures across their portfolios. Reinsurers lack access to the tools for calculating potential affirmative cyber exposures within cyber policies and silent cyber exposures within other P&C policies, leaving them exposed to unexpected cyber losses.

The solution

The joint Sapiens and Kovrr solution delivers transparent, real-time data- driven insights into affirmative and non-affirmative single, accumulated and catastrophic cyber risk exposures. The Kovrr platform is designed to help underwriters, exposure managers and catastrophe modelers better understand, quantify and manage cyber risk by utilizing AI-powered predictive risk models. Kovrr uses customer data from Sapiens and other sources and the underwriting insights can be integrated to the overall underwriting, according to the insurance product.

Industry challenge

The risk and the exposure to new forms of fraud is increasing. The innovation and digitalisation disrupting the insurance industry creates new opportunities for carriers but also for fraudsters. Insurance fraud undermines the capital needed to pay genuine claims and is an additional tax on every policyholder.

The solution

Fighting fraud is Kube Partners’ primary mission. We work for the greater good, and with our anti-fraud platform Detector, we will reinforce this fight at a global level.

Developed with the contribution of experienced claims handlers, Detector is an advanced cloud-based software platform to provide end-to-end fraud detection and to empower experts to make the right decisions. Our customers have enjoyed a 400% improvement in the number of cases successfully investigated and a 300% improvement in fraud detection efficiency. With our fast implementation path, insurers can go live in as little as 4 to 6 weeks and the initial investment is fully repaid in just a few months with a 10X return on investment.

Business benefits

• Accurate scoring, minimise false positives
• Acceleration of the settlement process for genuine claims
• Full automation: Detector claim scoring and investigation workflow ensures cost and productivity monitoring
• Easy-to-use SaaS platform: intuitive, self-explanatory and simple-to-use and integrates with company’s system, Detector provides real-time proof of fraud
• Multiple lines of business supported (motor, property, health, travel, general liability, personal accident, pets)

Industry challenge

Several industry reports estimate fraud to be around 10% of the entire insurance gross written premium for P&C. This represents total losses of more than $40 billion for P&C insurers in the US and more than $55 billion for P&C insurers in Europe. In addition, fraudsters are becoming more innovative, deploying complex fraud patterns. SIU teams find that rules-based solutions are less reliable and more labour-intensive when faced with novel fraud techniques.

The solution

Shift Claims Fraud Detection is an AI-native solution that lets investigators discover more fraud, faster, and throughout the entirety of the claims process. Our solution leverages the collective knowledge of over 200 data scientists and over 100 external data sources – including trusted fraud detection resources such as Lexis-Nexis and the NICB. G71By combining insurance-specific intelligence and data, Shift Technology creates a solution that lets investigators find and mitigate more fraud while encountering fewer false positives. This improves the customer experience and creates cost savings that P&C insurers can pass on to their policyholders.

Business benefits

• Powerful AI solution grows hit rate by 3x
• Reduce false positives to drive more efficient workflows
• Identify both simple and sophisticated fraud techniques
• Clear context for 60% faster resolutionShift Technology is enabling P&C insurers to see more, do more, and be more for their policyholders. Decisions shape the insurance industry. P&C insurers must make the correct decision, quickly, in every policyholder interaction, from underwriting to claims and beyond. Shift’s AI solutions effectively automate and optimize insurance decisions, liberating insurers to innovate and find new ways to be there for their customers.
• More accurate decisions about fraud and misrepresentation at the point of underwriting and policy
  activation to reduce leakage
• AI-native claims fraud detection that effectively identifies individual and network fraud schemes and
  provides contextual guidance for investigators
• More efficient and accurate decisions at the point of claims first notice of loss (FNOL), including AI
  document intake and analysis, and verification of claims details
• More efficient use of human expertise thanks to insurance-trained AI that can handle many routines and
  complex tasks
• Support for compliance efforts including Know Your Customer (KYC) and Anti-Money Laundering (AML)
  initiatives

Industry challenge

Dozens of eMerge-based solutions are currently operated on IBM Z platforms. As eMerge has evolved through the years, most of the solution’s investment was exposed to external technologies adjusted that needed support of eMerge versions.

The solution

Together with eMerge IBM Z customers, Sapiens continues to enhance IBM Z platform capabilities. We are continuously improving our eMerge product to support the latest releases and functionality of IBM Z Systems customers to maintain their workload.

Business benefits

• Consistency The new back-office applications have a unified look and feel, with the reuse of web services across the various applications.
• Repository System All data from the applications are centralized in IBM Z. This can save unnecessary web services when an application needs data from a second application.
• Compliance with regulations The new application is regulations oriented.
  Digital services No more paperwork, hand files and file cabinets, no duplicate data, no business errors, everything is validated by the application.
• Accessibility The new eMerge applications on IBM Z are accessible for intern

Industry challenge

Today’s insurance industry is facing rapid change and heightened customer expectations. This is in addition to the “cost-conscious” customer, who frequently switches carriers. Now more than ever, insurance leaders are seeking transformation, innovation, and reduced expenses.

The Solution

Sapiens, in partnership with Microsoft, is an extensive technology and go-to-market strategic partnership enabling intelligent insurance and empowering more personalized and enhanced experiences.

Business benefits

• Microsoft Azure is our cloud provider for Sapiens Cloud
• Sapiens & Microsoft – integrated across Microsoft’s portfolio, including Azure, Microsoft 365, Power BI. Roadmap: Dynamics 365.
• Sapiens’ solutions are surfacing in the Azure Marketplace
• Sapiens is working closely together with MS product teams