The Swedish insurtech company Mavera automates claims management by connecting people with data and medical expertise. Today they released new features using artificial intelligence to help insurers improve efficiency and customer engagement.
Reviewing recommended treatments
In health insurance, a big challenge is to validate the medical necessity of treatments suggested by private caregivers. Some caregivers recommend medical surgery instead of other alternatives, such as rehabilitation or physiotherapy. This leads to high costs for the insurer and could expose the patient to unnecessary risk.
To help the insurer decide on what treatments to approve, Mavera has developed an AI system that helps detect suggested treatments that may not be medically motivated. The insurer can then investigate the case further and ask for a second opinion from a medical advisor.
Process time prediction
The following AI feature is an algorithm calculating how long it will take for a medical advisor to process a claim. It enables the claims handler to automatically assign the claim to the medical advisor with the shortest process time and keep the claimant informed on the process, improving transparency and customer engagement.
The International Classification of Diseases (ICD) is an international standard maintained by WHO for health care classifications. It describes the injury in detail and is an important data point to collect from every claim. It helps insurers understand their customers and operations better and, at the same time, fuels new automation.
There are over 70 000 unique codes, so it is hard for insurance companies to collect them. Generally, they only associate less than 15% of their complex claims to an ICD code. To improve this, Mavera has developed an AI feature that scans the claims documentation for descriptions of the injury and identifies the correct ICD code. Claim handlers and medical advisors only need to verify the ICD code with this support.
“We are happy with the release and the initial feedback from our customers. It is an important step in developing Mavera DSS, and many more releases are to come”, says Johan Larsson, CPO at Mavera.