Tuesday, June 4, 2019

AI For Underwriting & Claim

Image result for AI for insuranceCustomer data is essential for insurance firms to stay competitive in the coming decade. Insurance companies at present have backlogs of data on past and existing customers in the form of policy agreements, applications, and claim forms. They’ve also collected millions of images showing car damage, property damage, and personal injuries.
Patterns exist within this data that could inform the decisions of various insurance departments. Discovering these patterns, however, is a challenge. People are generally very good at finding patterns within datasets, but this ability dulls as we’re presented with more and more data. A team of chief claims officers, for all intents and purposes experts when it comes to dealing with claims data, might still spend months sifting through millions of claims forms to garner any reasonably accurate insights from them.
This challenge is compounded because large insurance enterprises are still not entirely digital. In other words, this backlog of claims forms and policy agreements is still partly a collection of paper documents. Older documents are likely stored off-site in various locations cross the region the insurance firm is operating in. Global firms may even store these documents in other countries.
What this means is that there are entire time periods of insurance data that are difficult to access at any given moment. Most insurance firms also still accept paper claims forms and applications, and they take payment and send claims payouts via check.
Not only that, but even digital information can be stored in systems that don’t communicate with one another. The claims department at a large division of a global insurance enterprise might use a completely separate system for dealing with claims forms than the underwriting department at another division of the same enterprise. As a result, insurance firms struggle to keep all of their customer data in the same location.
For example, if an employee at a nation-wide auto insurance enterprise wanted to figure out the optimal premium that a customer should pay, they would need to find patterns across similar customers. Perhaps the customer is in their 40s, puts 300 miles on their car every week, and lives in a high-crime area. How much is this customer worth to the insurer?
That isn’t something one can accurately determine without aggregating the lifetime value of every customer of a similar demographic. This would require underwriters to sift through thousands of past customer records, including the claims that customers of this demographic tend to file, the length of which they stay on the policy, and how much their premiums have been historically (which could vary wildly for a number of reasons).
These documents may or may not be digitized, and so underwriters may in some cases need to look through boxes of paper documents in order to find policy agreements, claims forms, and other documents belonging to customers that fit the demographic. This is a rigorous and time-consuming task, and so underwriters tend to settle for historical precedent that’s easily accessible to them when determining premiums.
Artificial Intelligence, on the other hand, is quite good at dealing with large volumes of data. Whether or not AI upends the insurance industry remains to be seen, but some of the largest insurance enterprises in the US are already implementing AI solutions for functions such as customer service.
Information extraction, otherwise known as document search or “document understanding,” as Iron Mountain calls it, is a more nascent use-case for AI in insurance. That said, we suspect that in the coming few years, this use-case will become more ubiquitous in the insurance industry. This is because information extraction software promises to reduce the time that underwriters and other insurance employees spend searching through documents.
The ability to search through digitized documents is made possible with natural language processing (NLP); the ability to digitize paper documents so that they’re searchable with an NLP software is made possible with machine vision. More specifically, optical character recognition (OCR) serves to read printed and handwritten letters and transcribe them into digital text.
AI-based information extraction and document search could prove useful in insurance. In this article, we discuss several use-cases for AI-based document digitization and information extraction in insurance, such as claims processing, underwriting, and human resources.
Digitizing Paper Claims Forms and ImagesInsurance enterprises struggle to answer simple questions about how to price their policies for maximum profit and how to accurately adjust claims for minimal claims leakage. This in part is due to the inability to access historical customer data that in many cases is stored in physical documents.
Digitizing these documents is the first step in extracting information from them, and it’s a necessary step for feeding the data in these documents into an artificial intelligence algorithm.
At present, a claims adjuster that wants to determine the optimal payout to a customer whose home is partially flooded may need to search through past paper claims forms to get a sense of what customers were paid historical for similar damages.
The key is that “similar damages” is subjective and requires discretion on the part of the claims adjuster. Adjusters often need to look at the images customers provide and make an assessment about how much repairs might cost based on a variety of factors.
Two different adjusters might look through the same claims form and the same images and come up with different payout amounts. Both of these amounts might be more than what the damage actually costs to repair, and the insurance company won’t find this out until later.
Artificial intelligence could help claims adjusters reduce claims leakage, but only if the claims forms and images attached to them are digitized. Employees at the insurance firm could scan physical documents and photographs, turning them into PDFs or image files.
Another feature robust platforms may offer: the ability to find similar images. Adjusters can simply ask for similar images to the one showing the damage for the claim they are working on and quickly find relevant claims that had similar damage.”
Then, an OCR software could transcribe the letters on the documents into digital text, thus making the text “machine readable,” or ready for feeding into a machine learning algorithm. After training the algorithm to suit the insurance firm’s purposes, an employee would in theory be able to search for specific information within these documents.
For example, they might be able to pull up historical claims forms for property damage of a certain amount. This would reduce the time adjusters spend searching through paper documents for the same information.
Machine vision software for image recognition could also classify images of damage by damage severity and by the amount that was paid out to the customer for that damage. This classification could be used as a factor for determining the optimal payout on a claim.
This would entail a prescriptive analytics capability that would use a customer’s demographics, the text information on their claims form, and the images attached to their claims to suggest the optimal payout for that customer’s claim. This is also why claims processing and adjustment are underdeveloped use-cases for AI in insurance. They require a robust network of machine learning capabilities involving natural language processing, optical character recognition, machine vision for image recognition, and prescriptive analytics.
We’ve been researching AI in insurance for years, and we can count the number of vendors that claim to offer AI solutions for claims adjustment and have the talent requirements to back it up on our hand. Even those companies can only offer their solution to very specific types of insurers. In other words, a legitimate AI vendor selling a solution for auto insurance claims generally doesn’t market their software for property insurance or health insurance.

Information Extraction for UnderwritingAlthough prescriptive analytics capabilities are rare in insurance due to the varied types of data (text, image, numeric), claims adjusters and underwriters can still use natural language processing software to search through their stores of documents once they’re digitized. This could prove beneficial because even digital documents can be unorganized.

Many exist in a variety of different systems across an insurance enterprise’s divisions and branches. They may even exist in different folders and organizational structures within the same department at the same branch. AI could help search through these disparate data sources, emphasizing the value of AI for this scenario:
In addition to enriching the metadata by extracting information from the documents, there could be metadata that you have in a repository already, it could be metadata that’s available out in the market for purchase, it could be publicly available information…the key is to be able to create the relationship between all of these different bits and pieces and making it all part of the metadata that’s attached to an asset.
This “asset” in this case could be a particular insurance customer or an insured property.
An information extraction and document search application could prove useful for searching through digital documents across the insurance firm’s numerous branches if those documents are stored in the cloud or some file-share program.
For example, an underwriter might be able to answer the question “Should I onboard this customer?” much faster than they would if they had to manually search through digital documents one by one for information that might help them answer that question. Instead, the underwriter could pull up records from past customers similar to the customer they’re looking to onboard.
The underwriter could then search through these records for information about claims the customer has made and customer lifetime value, and this could give them a better idea of whether or not to onboard the potential new customer. It might also inform the premiums they offer that customer.
An underwriter could make their decision about the customer in a matter of minutes as opposed to the hours or days it may take them to do so manually. This has clear savings benefits for the insurance company, as well as customer experience benefits. It could allow an insurance firm to move closer to offering “on demand insurance,” the ability for an insurance company to onboard a customer when the customer needs insurance (such as the day they’re diagnosed with an illness).
Insurance firms are scrambling to cater to millennial customers, who more than any other generation expect a level of speed congruent with their experience growing up with the internet. They don’t find it necessary to show up at a physical location and discuss their insurance policies. They want to be able to apply via chatbot or email, and they want to start their policies very shortly thereafter. AI-based information extraction software could help with this, potentially giving insurance firms that integrate it an edge over their competitors.

The Bottom Line – What Insurance Firms Need to Know - Claims processing and underwriting are two areas of insurance that could benefit from AI-based information extraction/document search software. That said, neither are developed use-cases for AI in insurance right now. This will likely change over time as AI becomes more accessible to businesses, perhaps with autoML or shift in the culture f innovation at older enterprises. At that point, AI use-cases in insurance will likely move from the cost-saving benefits of document search applications to more complex machine learning systems that involve document search, machine vision, and prescriptive analytics, allowing for capabilities that drive growth, such as tailor-made insurance policies.

For now, information extraction and document digitization software could reduce the time underwriters and claims adjusters spend searching for information through paper and digital documents that they regularly use to make decisions about premiums and claims payouts. A less laborious and more organized search process could result in more profitable premiums and less claims leakage, although without a prescriptive analytics function, the premium and payout amounts are still left up to underwriters and adjusters (in other words, human error).
For now, information extraction and document digitization software could reduce the time underwriters and claims adjusters spend searching for information through paper and digital documents that they regularly use to make decisions about premiums and claims payouts. A less laborious and more organized search process could result in more profitable premiums and less claims leakage, although without a prescriptive analytics function, the premium and payout amounts are still left up to underwriters and adjusters (in other words, human error).
At the same time, there are ways to mitigate spend and achieve a quicker time to market. Currently there aren’t many AI vendors that offer products clients can use “out of the box” or that are “plug and play,” so to speak. Those that offer something close to this are often in customer service or similar horizontals that don’t differ much from company to company, although it’s very likely that these products still require training on the part of the client.

Fighting Fraudulent Claim At Socso

Image result for socso
Having been hit with RM30mil in losses as a result of false claims stretching back seven years, the Social Security Organi­sation (Socso) has decided that enough is enough. It is now training its guns on syndicates and other third parties putting in false claims on behalf of contributors.
Investigations showed that there are syndicates operating to influence contributors to exaggerate their injuries for them to stand a better chance of claiming life-long benefits.
Last year, Socso’s anti-fraud depart­ment detected 99 claims believed to be fraudulent. As of Jan 1, two cases were brought to court, one of which involved a syndicate leader.
Overall, Socso, which provides social security protection to a 6.3-million-strong workforce (excluding foreigners) and their dependents through the Employ­ment Injury Scheme and the Invalidity Scheme, has identified about 200 false claims, some of which date back to 2012.
Besides ordering an audit trail, CEO Datuk Seri Dr Mohammed Azman Aziz Mohammed disclosed that Socso was looking at introducing an online system for claims with all applications, approvals and payments handled “with minimal intervention”.
“We hope to get it done by the year end and have it running next year. I am pushing my staff members on this. We hope this will put an end to any third party interference,” he said in an interview at his office here yesterday.
Mohammed Azman said of the 200 claims, 145 were referred to the police, Malaysian Anti-Corruption Commission and other bodies. Cases were also filed in court, he said.
“Third parties will instigate contributors and tell them that they have to do certain things to get their claims approved.
“This is what we have known from our experience. Our stance is that all claims are genuine until proven otherwise. If you want to challenge the system, be prepared to face the consequences,” he said.
Mohammed Azman explained that as Socso claims were handled by employers, contributors or their dependents need not rely on third parties or runners.
He said in the event of a mishap, an employer need only prepare a report and submit the claim to Socso.
He said the majority of claims were approved as long as they were certified by employers, adding that the necessary arrangement for payments was done accordingly by Socso.
“But somehow in some cases, a third party is involved to facilitate the claims. They use all sorts of excuses to convince the contributor that if they go through them, approval will be expedited because they claim to know someone in Socso. These runners then try to get a cut from the contributors or depen­dents,” he said.
Mohammed Azman explained that the processes involved were straightforward and as such, there was no need for outside help.
“People should think twice when anyone comes and tells them that they can help get Socso claims approved,” he said.
He challenged the notion by some that Socso was an organisation muddled with red tape, adding that the body had been proactive in reaching out with its “Skuad Prihatin” (caring squad) to contributors in need of assistance.
“Even cases reported in the media, as long as we get their MyKad numbers, we cross-check with the system and if they are registered with us, we are there to help. So why go through middlemen?” he asked.
Mohammed Azman said Socso held its open day every Tuesday (8.30am to 10.30am) at all its branches nationwide and welcomed those who have doubts or problems to seek help.
“I have given directive to all office managers and state directors to be present to entertain queries. This is also applicable at the headquarters and my deputy or me also have to be at the counters to provide assistance,’’ he said.

Saturday, June 1, 2019

Tobacco & Tuberculosis Killing Indonesia

Image result for Indonesian smokerIn the next few years, Indonesia is expected to jump from a lower-middle to an upper-middle economic position, according to its gross national income per capita. However, beneath the economic growth, there is an iceberg of a threat from a triple burden of diseases: infectious diseases, noncommunicable diseases (NCD) and reemerging diseases.
Without significant intervention, in the long run the burden will become a plague that hinders the growth of human resources and economic growth as a whole.
Tobacco has been one of the issues over which the government is still in limbo choosing between economic growth and the quality of human resources. As a country with the largest prevalence of male smokers in the world, tobacco is a commodity that contributes to the state revenues. On the other hand, tobacco consumption has a very broad impact not only on health, but also on other socioeconomic aspects.
For example, Statistics Indonesia (BPS) in 2016 found that 40 percent of the smoking population from the lowest income level spent 11.5 percent of family income per month on cigarettes, hampering the members from attaining their minimum daily calorie intake. Furthermore, a study done by Mark Goodchild and others in 2017 discovered that 21 percent of chronic smoking-attributable diseases in Indonesia are estimated to cause an economic burden of US$1.2 billion per year.
The World No Tobacco Day this year focuses on “Tobacco and Lung Health”, emphasizing the multiple ways tobacco affects the health of people’s lungs, including the association with tuberculosis (TB) infection. In fact, tuberculosis has become one of the top health priorities both in the world and in Indonesia, with the view of eliminating the disease by 2030. Although the bacteria is found to have infected people for thousands of years, TB remains the fourth leading cause of death in Indonesia and Indonesia has the third highest burden in the world.
There are links that need to be considered here. A study by the World Health Organization in 2009 showed that more than 20 percent of TB incidents globally were related to smoking habits. Smoking increases a person’s risk of being infected with TB by up to 2.5 times. It was found in 2014 that regular tobacco smoking doubles the risk of people who have been successfully treated for TB to develop the disease again.
Tobacco is the fourth highest risk factor for health in Indonesia. The fact that five countries with the highest TB burden also have high cigarette consumption suggests that controlling cigarette consumption may reduce the risk of TB infection and the occurrence of new cases, which would help Indonesia achieve the goal of TB elimination by 2030, as well as reduce NCDs related to smoking.
The government has made various efforts to deal with TB. Unfortunately, in regard to tobacco control, the government’s commitment is regretfully weak. Up to now, Indonesia has not yet ratified the Framework Convention on Tobacco Control (FCTC), which is an important international framework for tobacco restriction and control. Furthermore, at the end of last year the government dropped a decision to increase tobacco excise and annulled the road map for the simplification of excise structures.
The cancellation of these policies allows tobacco producers to sell their products for less than Rp 1,000 (7 US cents) per cigarette, making them affordable for children and the poor. No wonder the Health Ministry’s Basic Health Research (Riskesdas) shows a significant increase in the prevalence of young smokers from 7.2 percent in 2013 to 9.1 percent in 2018. Worse still, our National Health Insurance (JKN) continues to suffer a huge deficit, partly to cover the treatment of catastrophic diseases that are significantly related to smoking.
After his reelection, President Joko “Jokowi” Widodo said he would focus on human resources development in his second term, which has been outlined and mapped in the Technocratic Draft of the National Medium-Term Development Plan (RPJMN) 2020-2024 of Indonesia. Part of the plan is to decrease the prevalence of smokers year by year.
Later in October 2019, the new government of Jokowi is expected to prove its commitment to human resources development through aligned policies that have leverage for increasing the productivity of human capital.
To control cigarettes specifically, in the short term, the government must increase cigarette excise and reduce the complicated excise structure. Excise Law No. 39/2007 only imposes a maximum ceiling of 57 percent of the retail price, which is not enough and still allows cigarettes to remain very cheap. A significant raise in the price of cigarettes is the most effective instrument today to reduce cigarette consumption, according to many studies, and, of course, to reduce a person’s susceptibility to TB infection.
In the long term, the government must ratify the FCTC as a statement of its serious commitment to improve and protect Indonesians’ health. That way, the target to eliminate TB by 2030 can be achieved and economic growth, as well as human development, would go in parallel, supporting each other sustainably.

BPJS Kesehatan Protects 83.49% of Indonesian

Image result for BPJS KesehatanThe Health Care and Social Security Agency (BPJS Kesehatan) has revealed that 83.94 percent of the  population, or 221 million people, are registered under the National Health Insurance and Healthy Indonesia Card (JKN-KIS) program.
The state-owned agency's customer service and expansion director, Andayani Budi Lestari, explained that about 32 million people were registered as employees of private companies.
“There are 265,455 companies that have taken part in the JKN-KIS program,” she said at the Indonesia Stock Exchange (IDX) after signing a cooperation agreement with the IDX on adding new members to BPJS Kesehatan.
Under the agreement, BPJS Kesehatan will provide the IDX with data about prospective investors and companies at the bourse, while the IDX will provide BPJS Kesehatan with data on potential members of its health insurance program.
The cooperation aims to encourage companies and their employees to take part in the JKN-KIS program, as required by law, Andayani said.
She said the cooperation agreement would also help BPJS Kesehatan to disseminate program information to companies listed on the IDX, including those expecting initial public offerings (IPOs).  
“Our target is all companies already listed on the IDX and those wanting to join the bourse,” Andayani added. (bbn)

Tune Protect Group Expanding In Asia

Image result for tune protect to expandTune Protect Group Bhd has been in talks with a Vietnam-based insurance company to pursue a stake, in line with its plan to increase the portfolio in the insurance technology (insurtech) segment.
Tune Protect CEO Khoo Ai Lin said the stake acquisition is expected to be completed by year-end.
“We want to make sure the company we are looking at is aligned with our business direction. We are not in a rush, although we are a little bit under pressure. We don’t want to look at this company just as a vendor. In fact, we have been discussing and it is now close to be completed,” she told reporters at the group’s AGM in Kuala Lumpur yesterday.
The insurer had partnered with Indonesia’s PT Asuransi Buana Independent and Association of Indonesian Tours and Travel Agencies East Java to distribute travel insurance through an integrated business-to-business online platform.
Recently, the group acquired 9.9% of equities in a UK-based insurtech start-up, Laka Ltd, for RM2.64 million to widen its distribution in the digital platform.
Khoo also said the group had embarked on its strategic plan, which is expected to increase Tune Protect’s policyholders to 42 million by 2022.
“The strategic plan, named GAIN, is a three- to five-year plan. It will take time in terms of heightening our capabilities.
“Our aspiration is to get about 42 million policies within three years. Currently, we are doing about 10 million policies each year. It is supposed to gradually increase to 14 million over the period.”
Meanwhile, Tune Protect corporate development and investor relations head Koot Chiew Ling said the group is expected to contribute 4% to revenue growth through the “dynamic pricing” mechanism that was introduced via AirAsia online platform.
“We have seen a good traction when we launched the mechanism in January. According to the indication, we are on track to achieve the target.
“It has been rolled out to Singapore, Thailand and Indonesia which are the four largest market of AirAsia,” she said, adding that the group does not discount the possibility to introduce the mechanism in its other airline partners.
Dynamic pricing is a mechanism to determine the targeted audience portfolio that able to customise travel insurance packages according to the travellers.
Tune Protect is collaborating with several airlines — namely AirAsia Group, the Phillipines’ Cebu Pacific Inc and an Emirati low-cost airline Air Arabia — to distribute its travel insurance.
On its voluntary separation scheme (VSS) exercise, Khoo said the group is unlikely to shed more employees in 2019.
“We have offered the VSS last year because we are moving towards a digital space and have been adopting automated processes. For now, I think we are good,” she said.
Tune Protect completed its VSS exercise with RM4 million in payout to 58 successful applicants in December last year. The reduction] involved 15% of the unit’s permanent workforce at its 83.3%owned subsidiary, Tune Insurance Malaysia Bhd.
Yesterday, Tune Protect’s share price closed two sen or 3% higher to 68 sen with a market capitalisation of RM551.2 million.