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Intelligent Claims Adjudication

AI based solution to streamline claims processing

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CDH based claims adjudication solution for claim adjustors that can be configured and integrated with existing claims processing workflows. The solution supports both CDH adaptive models and external AI models imported as PMML. This solution help carriers: • Reduce the need for investigations and save costs and time • Increase claim adjudicator capacity with time savings • Improve accuracy in decision-making and reduce carrier liability • Expedite claim settlement for greater customer satisfaction, renewals, and referrals. • Boost agent satisfaction with simplified decision- making systems

Key Features

  • An Adaptive Model with predefined predictors that have been trained using sample claims data.
  • A Predictive Model that incorporates an External AI model (Python) imported via PMML in Decision Studio.
  • A Pega Application that emulates the Claim Adjuster Workbench, enabling the utilization of these models to assist claim adjusters in their decision-making process.
  • Transparency and explainability, presenting predictor performance through spider graphs, instilling confidence and clarifying the rationale behind our AI recommendations.
=Virtusa Corporation

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