EXL Insurance LLM

Use Case Details

Generic LLMs fall short in addressing nuanced challenges faced by insurance companies during claim adjudication, leading to inefficiencies, high indemnity costs, claims leakage, slower claim settlement timelines, and compliance risks. Claim leakage, monitoring, and compliance are central issues in the insurance industry. The major causes of these are human errors, process inefficiencies, and inadequate training.

The impact on insurance businesses is significant:

Financial Impact: Both claim leakage and non-compliance can lead to considerable financial losses. Inefficient monitoring might allow these issues to go undetected until they've caused serious damage.
Operational Disruptions: Non-compliance can result in legal actions, penalties, or even suspension of business operations in severe cases.
EXL’s proprietary insurance LLM addresses these challenges directly. By leveraging 25 years of deep industry expertise and 10+ years of proprietary labeled data, EXL’s LLM delivers 30% more efficient and accurate responses than competing models, reducing costs for clients by up to 30%. It streamlines claim processing, reduces leakage, ensures regulatory compliance (including PII/PHI de-identification), and helps companies avoid the financial and operational risks associated with non-compliance and inefficiencies

Key Features & Functionality

our solution offers powerful features designed to streamline insurance workflows, providing precision and actionable insights for faster, smarter decision-making. Here are the key features:

• Medical Record Summarization: Automatically extract and summarize complex medical records, delivering concise insights that save time and reduce manual effort.
• Claim History Compilation: Efficiently compile claim histories from assorted notes, transcripts, and documents, providing a comprehensive view of each case for more informed decisions.

These features enable insurers to drive efficiency, reduce costs, and make better decisions, ensuring compliance and operational excellence.

Benefits & Business Impact

Benefits of EXL’s Insurance LLM:

• Efficiency: 30% faster claims processing and decision-making, reducing operational delays.
• Cost Savings: Achieve up to 30% cost reduction by minimizing claim leakage and inefficiencies.
• Compliance: Ensure regulatory adherence, including PII/PHI de-identification, mitigating legal risks.
• Accuracy: Industry-specific insights lead to fewer errors and optimized claims outcomes.
• Business Impact: EXL’s LLM drives cost savings, operational efficiency, and compliance, leading to stronger financial performance and customer satisfaction.