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How AI and Automation Make Humans More Human in the Claims Process

Written by Roger Peverelli and Reggy de Feniks - Founders The DIA Community on Oct 31, 2023

The human touch is what clients will remember most in the claims process. It defines your brand. So, what does this mean for the increased application of technology to speed up processes and make them more efficient and accurate?

We sat down with Rogier Halvers, Managing Director at Van Ameyde Systems, and Erik Leung, Co-Founder and Chief Product Officer at Simplifai. In this interview, they dispel the myth that technology lessens customer experiences. They also explain how AI-powered automation empowers claims handlers to become more human by removing mindless work such as data entry, creating insights for claim handlers and increasing speed via process automation.

How do humans and tech empower each other in claims handling?

Rogier: “The symbiosis between humans and IT is important – now more than ever with the increasing popularity of AI tools. There is a fear that AI will replace jobs in the insurance industry and that insurance companies will lose their empathy when dealing with clients in the “moment of truth” – the claims process. This is not true at all. By automating repetitive tasks, humans have time to actually be more human, empathetic and productive in handling claims, which will accelerate the speed of the process. Releasing people from “grunt work” such as data entry and repetitive task work unleashes the power of the person involved and certainly does not replace him or her with a Bot-type technology. This is especially relevant because demand is growing for more claims personnel in the industry.”

How does Van Ameyde handle the combination of tech and human power?

Rogier: “At Van Ameyde Group, we have handled the claims process with hardworking, innovative people for over seven decades. It is this human intelligence which empowers our digital transformation with AI supported processes and IT systems. Our claims handlers bring the perfect amount of human heart and human touch to the process. Furthermore, who would know better than our teams of claims handlers what is needed from a tech platform, when you process 800,000 claims annually across all insurance business lines? Using their expertise as input, in 2007 Van Ameyde, introduced a system for claims handling called ECHO, which is now being used in all our 46 subsidiaries and by external parties in multiple countries. ECHO is a process handler that guides the claims handler throughout the entire claims process – from first notice of loss (FNOL) until closure of claims. Simplifai is behind the scenes, supporting us and accelerating our business performance through AI-powered automation that keeps our claims handling system running and allows our claims handlers to take on more complex tasks.”

What are the important aspects when implementing such a solution?

Rogier: “The three most important aspects for Van Ameyde Systems are: human efficiency, process connectivity, and intelligent data. First and foremost, our systems exist to make humans as efficient as possible by automating repetitive processes that do not need human intelligence. Of course, this is done in an intuitive, user-friendly system environment. Secondly, the level of connectivity is very important so that each authenticated third-party interface can, for example, report a loss to us in a way that our system can understand what went wrong and begin to solve the issue. Thirdly, intelligent data is mission-critical, especially in the area of fraud detection.”

Can you elaborate on how ECHO works?

Rogier: “The claims handling process ECHO determines if the situation or object involved in the loss has insurance coverage and finds out who is liable for it. This main process is enriched with data analytics and robotics supported by AI technology provided by Simplifai. Simplifai’s intelligence empowers our platform by reading, classifying, and extracting incoming claims correspondence. The technology loads data entries directly into ECHO, allowing for an extremely efficient process that frees up claims handlers for more complex matters that call for human intelligence.”

Why is it sometimes still necessary to have a human in the loop?

Rogier: “During the claims process, claimants want to reach a resolution as quickly as possible. They want to be reimbursed or receive a replacement very fast. Especially when dealing with smaller claims like lost sunglasses or a shattered phone, people usually don’t mind talking to a bot. For incidents like these, and others, for example, a storm causing damage, we have a straight-through payout (STP) process. This means that an average person who has damage from a storm and has never claimed anything before gets an STP relatively quickly. On the other hand, if a claimant’s house has burned down, they still want the situation to be dealt with as quickly as possible, but there are so many objects and factors to consider, that it complicates the process quite a bit. The more complex the claim, the higher the likelihood that it is handled by human claims handlers. This way, all details are thoroughly accounted for, and the claimant receives human empathy, relatability, and assurance.”

What is your vision for the future of claims at Van Ameyde?

Rogier: “Our claims handlers fuel our digital innovation through their practical experience. This innovation and process automation, in return, gives humans more time to work on complex issues that require human intelligence and expertise. The most important thing for us at Van Ameyde is, through all our digital innovation and transformation, to maintain a strong connection between our employees and clients and support claims handlers with the necessary tools and time to be involved in the process and show empathy. It is not an “either/or story” between the human and IT factors, but, rather, an “and/and” story.  

To reach full efficiency, we are working towards full automation of the whole process to enable our claims handlers to work even more accurately and efficiently. In an ideal world, all aspects of the claims process would be connected in a straight-through process. For example, when someone gets into an accident, their car should be able to connect to our platform and tell us exactly what occurred. Then, we can connect with the customer and ask if they are alright, while we are already taking steps to solve the problem. Many think we only intervene when damage is done, but we also want to prevent as much damage as possible. For example, if we know a big storm is approaching, we want to be able to send a message telling you to secure your outdoor furniture or bring delicate objects inside. We also aim to automate the process of checking one’s trustworthiness, previous claims, extent of loss, and proof of purchase, for instance. This automated process saves time by automating simple aspects and enabling claims handlers to spend more time on more complex, time-sensitive, and even emotional matters.”

Can you elaborate on the benefits of your partnership?

Erik: “Together, Van Ameyde and Simplifai are debunking the myth that automation is evil, but, instead, can help our industry, employees, and clients tremendously. AI is not about replacing human jobs but enabling claims handlers to increase efficiency, especially considering the lack of staff throughout the industry. In addition, automation improves experiences and processes for clients and businesses by putting an end to negative experiences for claimants that may occur due to long waiting times before a problem is resolved. 

Van Ameyde uses Simplifai’s AI-powered automation in its IT platforms to maximize the time that claims handlers use on aspects of the process that require human empathy and intelligence. We foresee a world in which the human and IT factors really strengthen each other and improve the process, as well as the resulting outcome of the experience for all involved in claims within our industry.”

Who are Van Ameyde International and Simplifai? 

Van Ameyde is a company built on determination, optimism and hope with its roots in the embers of World War II. In 1945 Henry van Ameyde started as a motor claims adjuster to the Dutch army, involved in the country’s post-war reconstruction. In expanding his business van Ameyde started working with commercial insurers on improving their claims processes, becoming the number one claims adjuster in The Netherlands. They soon started opening offices abroad and now have 46 operating companies and 30 countries covered by their network. 

Simplifai: While studying in California, Erik Leung dreamed of leveraging IT to change how people work and make a real impact. He realized that many problems were caused by the lack of qualified labour and believed in the need to utilize human resources differently by freeing up capacity. He teamed up with technology consultant Bård Myrstad, to work on their shared vision of capitalizing on technology to address real-world problems. Based on this vision of changing the future of work, in 2017, Bård Myrstad and Erik Leung co-founded Simplifai. 

Rogier Halvers, Managing Director, Van Ameyde Systems
Erik Leung, Co-Founder and Chief Product Officer, Simplifai
Amsterdam 12-13 June

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