ACTINEO specializes in bodily injury claims and provides services to the insurance industry, especially in the insurance lines “third party/liability” and “private accident insurance”. Currently, the German company processes and digitalizes more than 120.000 bodily injury claims per year. ACTINEO develops prediction models and AI solutions for a customer base of more than 40 insurers. The portfolio includes process automation as well as digital instruments for case management and cost controlling in bodily injury settlement.

The challenge
In the insurance industry, bodily injury claims are still heavily undermanaged and under controlled, even though they have a huge impact on the overall performance. In motor liability insurance, for instance, bodily injury claims are responsible for almost 40 percent of the settlement costs. As a result of this lack of transparency within the claim settlement process, the industry faces problems in the detection of the medical escalation of bodily injury claims. Moreover, there is no detailed medical controlling or cost controlling system in the market. Nor does automation in the settlement process of bodily injury claims take place.

ACTINEO’s digital solution
In order to tackle these problems, the Cologne based Insurtech is developing, among other digital innovative products, the ACTINEO Cockpit, the digital manager of bodily injury claims. The platform fulfils three important goals for the bodily injury claim segment of the insurance industry:

• transparency in bodily injury covering the whole life cycle of a case
• case management (meaning “doing the right things at the right time”)
• controlling of settlement costs and reserves on a normalised basis.

It is a powerful tool for claim handlers who want an active management and ongoing controlling of bodily injury claims. The application is web-based and can be accessed via different roles and authorisations. It consists of different modules like a case manager, a reservation calculator, a medical WiKi and dashboards for the management.

How it works

Whenever ACTINEO gets assigned, the company collects medical documents from doctors and hospitals and extracts the medical information from the files received. Then all relevant medical data and injury characteristics are digitalised and normalised and added to a global data base. For the digitalisation, ACTINEO uses the ICD-10 code, which is the international classification of diseases, a WHO standard.
Based on the extracted information, the Case Manager within the ACTINEO Cockpit is a complete digital medical file with the medical status quo as well as a chronological history of the medical claim settlement process. The claim handler does not have to enter any data into the system in order to use it or to take advantage of it. The system is completely fed with data derived from the data extraction by ACTINEO.

Powered by predictive analytics
Furthermore, ACTINEO uses normalised medical data to come up with prediction models, for instance for the work disability or hospitalisation period, which also feed into the ACTINEO Cockpit. The planning of future interventions is made possible by an automated intervention system based on defined rules, algorithms and prediction models. Different scores and indicators, like a rehabilitation, a care and a fraud score, indicate to the claim handler a certain likelihood that the case in question may escalate, and leads him to further check and organise next steps.

Another feature of the application brings together the case data with cost positions, settlement data and reserves. The claim handler has transparency about how much money has been spent so far on different cost positions, like pain and suffering compensation or compensation for housekeeping expenses. Then he can decide whether to adjust the reserve that has been set for the claim.
Finally, for the management level, the dashboard tab in the system allows to either have an overview on the overall costs spent in different cost positions or to deep-dive to analyze what has been spent.

Why we selected ACTINEO for DIA Munich
In the insurance industry bodily injury claims are still heavily undermanaged and under controlled, even though they have a huge impact on the overall performance. ACTINEO has developed a powerful tool for claim handlers who want an active management and ongoing controlling of bodily injury claims.

Check out their live demo here:
https://www.itcdiaeurope.com/dia-tv/video/digital-manager-to-manage-and-control-personal-injury-cases-for-liability-and-accident-insurance/​

Who is ACTINEO?
ACTINEO was founded in 2009 with just one employee, a telephone and a computer. Today, the startup has a staff of 150 medical and IT professionals and is the German market leader for the digitalization and medical assessment of bodily injury claims. On behalf of insurance companies, the Cologne based company provides innovative, medically competent and data-based support throughout the entire claim management process.

Lars Klußmeyer (Managing Director), Olav Skowronnek (Founder and Managing Director) and Sebastian Steinfort (Head of Business Intelligence), ACTINEO GmbH, Germany.

https://www.actineo.de/