Claims overspend is one of the main concerns in the insurance industry.

There are many different kinds of claims leakage that might cause claims overspend, including inefficient claim processing or improper payments, human error, poor decision-making, customer service, or even fraud.

The overspend is usually discovered afterwards, through an audit of closed claim files. But what if insurers could predict this leakage even before it occurs? If an insurer is trying to figure out how to stop overspending, here are few ways that Utopia AI can help:

1. AI can produce cost savings for insurers

How can AI (Artificial Intelligence) produce cost savings for insurers?

It can be done in two steps, predicting and preventing the areas of greatest potential loss through claims leakage. This means that the insurer needs to identify right from the very outset of a new claim just where the overspend problems might arise.

Using the same information as is produced by an audit team, Utopia AI can help you apply this knowledge to all new incoming claims and help you take action in real time. Some insurers are known to lose up to 10% of their indemnity costs through claims leakage.

The Advanced AI that Utopia deploys is an amazing technology that really gets to the root of where claims overspend occurs – but with the added benefit of predicting the future and not just looking at the past.

2. Reimagine how you can prevent claims overspends

Traditional and current systems usually identify claims overspend only long after the claim is settled. How can one reimagine that kind of solution?

The insurance company would require a system that predicts in advance where the problems will arise. Utopia AI can do this and the customers can use this information to prevent losses from occurring for any type of claims.

So instead of looking backwards at what has already happened, when it’s too late to do anything except tune future processes, Utopia AI helps insurance companies take corrective actions in anticipation of the problem. In this way, companies can use all the tools at their disposal to reduce their claims costs before the overspend has occurred.

For example, Utopia AI can help them avoid the unnecessary use of external advisers. Because our system uses the same information that the claims audit team produces, Utopia AI can mimic human decisions. Furthermore, Utopia’s system of continuous learning and refinement enables a much better understanding of where the opportunities for savings will arise.