AI-Driven Claims Processing Transformation
Reducing claims settlement from 15 days to 3 days
Key Results
Client Overview
A Fortune 500 insurance company with diversified product portfolio:
- $10B+ gross written premium
- 10M+ active policies across P&C and Life
- 50,000+ agents and brokers
- Operations across 30+ countries
- 80+ years of industry experience
Challenges Addressed
Long Settlement Times
Average claims settlement taking 15+ days due to manual processing, document collection, and approval workflows.
High Fraud Losses
Estimated 10-15% of claims involving fraud or exaggeration, costing millions annually.
Manual Document Processing
Claims adjusters spending 60% of time on document review and data entry instead of decision-making.
Inconsistent Adjudication
Similar claims receiving different outcomes based on which adjuster handled them.
Poor Customer Experience
Customers frustrated with lack of transparency and communication during claims process.
High Operational Costs
Large claims operations team required to handle growing claim volumes.
Project Timeline
| Phase | Duration | Activities | Deliverables |
|---|---|---|---|
| Discovery & Analysis | 4 Weeks |
| Transformation Roadmap |
| AI Model Development | 10 Weeks |
| AI Model Suite |
| Platform Development | 12 Weeks |
| Claims Platform v1 |
| Integration & Testing | 6 Weeks |
| Integrated Platform |
| Rollout & Optimization | 4 Weeks |
| Production Deployment |
Solutions Delivered
Intelligent Document Processing
AI-powered extraction of data from claim forms, medical records, police reports, and repair estimates with 95%+ accuracy.
AI Fraud Detection System
Real-time fraud scoring analyzing claim patterns, network analysis, and behavioral indicators to flag suspicious claims.
Automated Claims Adjudication
Rules engine combined with AI for straight-through processing of simple claims and intelligent routing of complex ones.
Customer Self-Service Portal
Digital claims filing with photo/video upload, real-time status tracking, and AI chatbot for instant support.
Project Team Composition
Total team size: 27 professionals
Results Achieved
80% Faster Settlement
From 15 days to 3 days average
35% Better Fraud Detection
Reduced fraud losses significantly
90% STP Rate
For eligible claim types
40% Cost Reduction
In claims operations
45 NPS Improvement
Customer satisfaction surge
$25M Annual Savings
From fraud prevention and efficiency
Client Testimonial
"The transformation of our claims operation has been remarkable. We've gone from being an industry laggard to a leader in claims experience. Viprata's AI solutions have fundamentally changed how we serve our customers."
Chief Claims Officer
Fortune 500 Insurance Company
Viprata Software Services
www.viprata.com • [email protected] • +1 (916)-412-2232
For more information about this case study or to discuss your transformation journey, please contact us.
AI-Driven Claims Processing Transformation
Reducing claims settlement from 15 days to 3 days
The Client
A Fortune 500 insurance company with diversified product portfolio:
- $10B+ gross written premium
- 10M+ active policies across P&C and Life
- 50,000+ agents and brokers
- Operations across 30+ countries
- 80+ years of industry experience
The Challenges
Long Settlement Times
Average claims settlement taking 15+ days due to manual processing, document collection, and approval workflows.
High Fraud Losses
Estimated 10-15% of claims involving fraud or exaggeration, costing millions annually.
Manual Document Processing
Claims adjusters spending 60% of time on document review and data entry instead of decision-making.
Inconsistent Adjudication
Similar claims receiving different outcomes based on which adjuster handled them.
Poor Customer Experience
Customers frustrated with lack of transparency and communication during claims process.
High Operational Costs
Large claims operations team required to handle growing claim volumes.
Project Timeline
Discovery & Analysis
Activities
- Claims process mapping
- Fraud pattern analysis
- Data quality assessment
- Technology evaluation
Deliverables
Transformation Roadmap
AI Model Development
Activities
- Document extraction models
- Fraud detection algorithms
- Damage assessment AI
- Reserve estimation models
Deliverables
AI Model Suite
Platform Development
Activities
- Claims intake portal
- Adjuster workbench
- Workflow automation
- Customer communication hub
Deliverables
Claims Platform v1
Integration & Testing
Activities
- Policy system integration
- Payment gateway integration
- External data sources
- UAT and performance testing
Deliverables
Integrated Platform
Rollout & Optimization
Activities
- Phased production rollout
- Model performance tuning
- User training
- Continuous improvement
Deliverables
Production Deployment
Our Solution
Intelligent Document Processing
AI-powered extraction of data from claim forms, medical records, police reports, and repair estimates with 95%+ accuracy.
AI Fraud Detection System
Real-time fraud scoring analyzing claim patterns, network analysis, and behavioral indicators to flag suspicious claims.
Automated Claims Adjudication
Rules engine combined with AI for straight-through processing of simple claims and intelligent routing of complex ones.
Customer Self-Service Portal
Digital claims filing with photo/video upload, real-time status tracking, and AI chatbot for instant support.
Project Team
The Results
80% Faster Settlement
From 15 days to 3 days average
35% Better Fraud Detection
Reduced fraud losses significantly
90% STP Rate
For eligible claim types
40% Cost Reduction
In claims operations
45 NPS Improvement
Customer satisfaction surge
$25M Annual Savings
From fraud prevention and efficiency
The transformation of our claims operation has been remarkable. We've gone from being an industry laggard to a leader in claims experience. Viprata's AI solutions have fundamentally changed how we serve our customers.
Ready for Your Transformation Journey?
Let's discuss how we can deliver similar results for your organization.