GeniClaim

Overview

The current claims processing workflow for Life, Long Term Disability, and Waiver claims encounters major obstacles. Manual data entry, limited fraud detection capabilities, document validation issues, and challenges in retrieving policy information lead to inefficiencies, delayed processing times, manual errors, and an elevated risk of fraud. These shortcomings result in extended claim handling durations and a decline in customer satisfaction.

Maantic’s GeniClaim solution, powered by the Appian platform, transforms claims processing for Life, Long Term Disability, and Waiver claims. By integrating workflow automation and advanced Generative AI (GenAI), GeniClaim simplifies claims registration and expedites the entire process, from submission to resolution. The solution enhances operational efficiency, reduces manual efforts, and speeds up claim resolutions, offering a superior claims experience. With Appian's low-code automation, insurers can streamline processes and improve both operational accuracy and customer satisfaction.

Key Features and Functionality

GeniClaim simplifies claims process for Life & Death Insurance claims.

Major Solution Components:

• Workflow Automation: Integrates seamlessly with existing workflows for claims processing across Life, Long Term Disability, and Waiver claims.
• Generative AI: Employs advanced AI algorithms to improve fraud detection and document validation.
• Natural Language Processing (NLP): Supports swift claims registration using natural language inputs for more seamless beneficiary management.
• Data Analysis: Identifies potential fraudulent activities early in the claims process through comprehensive data insights.
• Dashboard and Reporting: Provides a user-friendly interface to track key performance indicators and metrics in real time. 
• Integration APIs: Connects with external systems and data sources for enhanced functionality and smoother data exchange.

Major Personas are:

• Claims Adjuster: Manages and evaluates claims, ensuring efficient processing and resolution.
• Claims Manager: Oversees claims operations, focusing on compliance, accuracy, and overall performance.
• Policyholder: Submits claims and interacts with the system for status updates and document submission.
• Customer Service Representative: Supports policyholders by providing updates and answering queries regarding their claims.

Benefits and Business Impact

The solution offered by Maantic's GeniClaim presents several key business values:

• Enhanced Efficiency: GeniClaim automates the entire Life Claim process, from First Notice of Loss (FNOL) to resolution, including the ability to manage payments for multiple beneficiaries and utilize AI-driven assignments.
• Improved Customer Experience: Features automated claim registration based on dynamic file ingestion, automated email correspondence, and document upload capabilities for policyholders, enhancing the customer journey.
• System Validation: Ensures accuracy with built-in checks for duplicate claims, validation against policy and regulatory data (e.g., DMF, OFAC), and cross-referencing with policy information.
• Fraud Prevention: Uses advanced analytics to detect suspicious patterns and anomalies, mitigating the risk of fraudulent claims early in the process.
• Accuracy and Compliance: Validates key documents such as death certificates and identification using GenAI to ensure they are complete and accurate.