Why AI Is No Longer Optional in Insurance?
AI automates routine decisions and evaluates straightforward claims in minutes, while maintaining transparency in complex cases. Let’s understand why it is needed.
Rising Claim Volumes and Operational Complexity
Insurance companies are drowning in data. Claims volumes have increased drastically from climate change-related disasters to increased digitization, creating more touchpoints for customer interactions. This rise has made the operations complex, fueling the need for nuanced evaluation, multiple decision points, documentation reviews, and risk assessments.
The limitations of Manual Processes
Traditional claims processing relies heavily on human judgment calls and basic digital tools that weren't designed for today's complexity. Claims settled for an individual may be justified for one insurer and unjustified for another, leading to disputes during inter-insurer claim settlement recovery.
Fraud Elimination
Human-centric processes struggle with fraud detection. Experienced adjusters can spot obvious red flags, but sophisticated fraud schemes often fly under the radar, leading to financial loss.
The Regulator’s Perspective on AI Adoption
The regulator's first priority is to keep consumers protected, enabling them to seek an AI model that can make fair decisions.
Ensuring Transparency and Explainability
The demand for AI transparency in the UAE and other jurisdictions means insurers must implement systems that provide step-by-step explanations for every automated decision. This may include explaining what, according to the policy, was covered and why a particular expense can not be settled.
Maintaining Compliance and Auditability
Regulatory compliance AI systems must be built from the ground up with comprehensive documentation that tracks every decision, data that was fed, and updates that were made, allowing auditors to follow everything during examination.
Ensuring Fairness
Regulators expect that insurance companies' AI models don't discriminate against protected classes. Insurers with audit-ready AI capabilities can have systems designed to produce evidence that meets specific regulatory standards.
The Insurer's Perspective on AI Adoption
Insurance companies seek an AI model that makes their operations efficient and manages risk, while staying compliant with local regulations.
One-stop Data Source
If customer data lives in one system, policy information in another, and risk assessments are scattered across many different platforms, creating transparency becomes nearly impossible. For insurers, having access to all required data in one location enables a unified data architecture in which information flows seamlessly between systems.
AI-driven Decision Consistency Across Claims
Thousands of claim settlements occur daily, and any mismatch in the decision outcome for two similar types of claims may lead to legal disputes. AI systems must maintain decision logic that's both transparent and consistent.
Reducing Confusion through Automation and Traceability
Disputes often arise from a lack of understanding about how decisions were reached. Modern insurance decision automation systems must generate detailed explanations that break down exactly which factors influenced each decision.
What the Future Holds for AI in Insurance?
- Eliminating traditional data silos and providing insurers with a single database, allowing real-time data exchange.
- Facilitate advanced fraud detection that not only spots the irregularities but also identifies patterns and predicts risks before they materialize.
- Analyze repair photos, police reports, and medical reports, and estimate a reasonable settlement cost.
Conclusion
AI has become a game-changer in the insurance world, and there's no denying that. The key is making sure AI systems can explain their reasoning clearly, which benefits everyone, from regulators to insurers, who want to understand why their claims were processed a certain way.
At Mosadad, we do precisely that. As a one-of-a-kind regulator-approved AI based motor claim settlement platform in the UAE, we help claimant insurers get their claim settlement recovered from the at-fault insurer in just a few days. Reach out to the Mosadad team to learn more.