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Claims Management

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Improve claims management with digital coworkers

Claims teams are constantly under pressure to deliver fast, personalized experiences. Meanwhile, your back and middle offices are overwhelmed, your combined ratio isn’t improving, and your profits are declining. Digital Coworkers can help.

Ensure you are hitting SLAs and adhering to protocols and process.

Your Digital Claims Assistant will enable greater speed and accuracy by:

  • Ingesting, analyzing, classifying, indexing and filing documents across systems and databases
  • Managing First Notice of Loss (FNOL) and First Report of Injury (FROI) processes
  • Supporting claims handling​ and servicing, including identifying missing or incorrect data or documents
  • Identifying, surfacing and following-up time-sensitive activity with adjusters e.g. legal demands within demand packages
  • Forwarding explanations of benefits (EOBs) and policy ID information
  • Entering data into systems as needed
  • Preemptively check for additional claimants at the address

Process lower complexity claims end-to-end and eliminate frustration throughout the claims process.​

An AI-powered Digital Claims Assistant has the capabilities to effectively support your adjusters by:

  • Classifying, indexing, extracting and relaying claims data into your systems
  • Creating and sending claims acknowledgement letters
  • Requesting additional data from the policyholder as needed
  • Screening for potential fraud
  • Calculating and setting reserves and paying claims

Eliminate unnecessary errors and costs, and alleviate stress from both your customers and your team.

Your AI-powered Digital Claims Assistant can supercharge your claims operation by:

  • Verifying Insurance coverage
  • Finding in-network providers
  • Supporting fraud investigations
  • Managing correspondence with policyholders
  • Closing claims
  • Administering benefits
  • Creating and distributing reports

Reduce cycle times and days-outstanding ratios.

You can trust your Digital Coworker to follow your set processes and recover your funds in a timely manner by:

  • Updating the claim throughout its journey
  • Identify accounts for recovery or subrogation based on value at stake
  • Complete and send any forms for third parties​
  • Communicate subrogation notices
  • Track status of the ongoing recovery​
Claims Receival & Data Entry

Ensure you are hitting SLAs and adhering to protocols and process.

Your Digital Claims Assistant will enable greater speed and accuracy by:

  • Ingesting, analyzing, classifying, indexing and filing documents across systems and databases
  • Managing First Notice of Loss (FNOL) and First Report of Injury (FROI) processes
  • Supporting claims handling​ and servicing, including identifying missing or incorrect data or documents
  • Identifying, surfacing and following-up time-sensitive activity with adjusters e.g. legal demands within demand packages
  • Forwarding explanations of benefits (EOBs) and policy ID information
  • Entering data into systems as needed
  • Preemptively check for additional claimants at the address
Claims Setup & Management

Process lower complexity claims end-to-end and eliminate frustration throughout the claims process.​

An AI-powered Digital Claims Assistant has the capabilities to effectively support your adjusters by:

  • Classifying, indexing, extracting and relaying claims data into your systems
  • Creating and sending claims acknowledgement letters
  • Requesting additional data from the policyholder as needed
  • Screening for potential fraud
  • Calculating and setting reserves and paying claims

Investigation, Adjudication & Settlement

Eliminate unnecessary errors and costs, and alleviate stress from both your customers and your team.

Your AI-powered Digital Claims Assistant can supercharge your claims operation by:

  • Verifying Insurance coverage
  • Finding in-network providers
  • Supporting fraud investigations
  • Managing correspondence with policyholders
  • Closing claims
  • Administering benefits
  • Creating and distributing reports

Recovery & Subrogation

Reduce cycle times and days-outstanding ratios.

You can trust your Digital Coworker to follow your set processes and recover your funds in a timely manner by:

  • Updating the claim throughout its journey
  • Identify accounts for recovery or subrogation based on value at stake
  • Complete and send any forms for third parties​
  • Communicate subrogation notices
  • Track status of the ongoing recovery​

Supercharge your Claims Operations

Trained on ever-expanding insurance data, documents, processes and systems – spanning life, health and P&C Insurance – Roxanne can handle 10x the volume of work of a human claims assistant.

Key Skills Include

  • Read and understand data held within documents and data (from emails, forms, systems etc)
  • Make decisions around eligibility and claims verification
  • Update systems and transact data to support all stages of the Claims Process
  • Work with colleagues to troubleshoot anomalies and exceptions
  • Continually update their own process, system & data knowledge

Key Responsibilities Include:

  • Receive, classify and index claims documents
  • Manage FNOL, FROI and claims correspondence
  • Analyze and extract data held within documents, emails, IT systems
  • Work with billing and collections team to progress payments and reimbursements
  • Automate tasks and activities across the entire claims process

Example System Knowledge

  • Guidewire
  • Duck Creek
  • Majesco
  • Microsoft Excel, Word, Outlook
  • EPS

Example Document Knowledge

  • ACORD forms
  • Demand letters
  • Medical claim forms
  • ID cards
  • Claims correspondence via email/mail
Meet Roxanne Here

Machine Intelligence + Human Ingenuity

By bringing together technology, data, machine intelligence & human ingenuity, our Customers realize significant value, fast.

Increase Capacity

Expand your human workforce up to 90% with trained Digital Coworkers. Better manage fluctuating peaks and troughs in demand. Avoid burnout.

Reduce Cost

Process more work, faster, with greater accuracy. No need to build Centres of Excellence or significant internal capability to manage your Digital Workforce.

Rapid ROI

Each Digital Coworker comes pre-trained with knowledge of documents and processes, enabling them to be operational from day 1. Typically driving 250% ROI for our Customers.

Adopt AI Faster

Our AI models and algorithms are configured to work out of the box, built on a deep repository of tagged system and document data. No need for expensive data, IT or infrastructure investments.

Avoid Disruption

Digital Coworkers plug into your existing ways of working, minimizing disruption and risk associated with extensive change programs

Improve Work

Eliminate the mundane, manual part of people’s work that typically slows them down, produces errors and causes burnout.

CUSTOMER SUCCESS

Our Customers see Digital Coworkers as important members of their team

“The Digital Coworkers Roots Automation provides work in conjunction with our Team to optimize our medical claims process. Our Digital Coworkers provide the simplicity and scalability necessary to deliver best-in-class productivity to our clients. Additionally, we value the insights from the Roots Automation Team about our processes, of which, we integrate into our continuous improvement plans for our business practices in order to provide industry leading solutions.”
Kevin Mahoney
President & COO, Carisk Partners
“Everything happened fast, our digital coworker ‘Roxy’ was trained and ready on time as promised! The team at Roots Automation have been a pleasure to work with! They’ve anticipated our questions and respond quickly to our asks and changes.”
Lea Lundquist
VP, Claims Administration, Protective Insurance
“We appreciate all of Roots Automation's efforts to automate a challenging initiative with 500,000+ transaction requests annually. Our internal Center of Excellence was able to get to production faster and more cost-effectively than what we originally planned.”
David Emmer
CIO, Anchin, Block & Anchin LLP
"Insurance companies have a desperate need to automate many business processes for efficiency, but current solutions are limited to rule-based tasks and aren’t insurance industry-specific, limiting their potential, Digital Coworkers lessen our stress over finding and retaining talent, and unburden our teams so they can focus on more impactful work. Roots Automation’s unique approach to automation has improved our employee retention while offering superior economics and enhanced customer experience".
Cathy Carr
VP of Insurance Support Services, Berkshire Hathaway Guard President
"Roots Automation has helped American Exchange automate and improve a lot of our internal data validation and data entry processes. This has both reduced our workload and has reduced human data entry error to almost zero. The best part is that our process with Roots Automation has allowed our agents to do what they do best, and that is talk to people and help them with their individual and Medicare health insurance decisions."
Andrew Hetzler
Chief Executive Officer, American Exchange

INSIGHTS, NEWS & RESOURCES

Webinars

Webinar: Unlocking Value with AI-Powered Underwriting

Register for our upcoming live webinar, where we will offer guidance, strategies and insights for your successful transition to AI-powered underwriting

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Whitepapers

Whitepaper: Transforming Commercial Underwriting with AI-Powered Digital Coworkers

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Whitepapers

Whitepaper: Transforming Claims Management with AI-Powered Digital Coworkers

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Blogs

Reflecting on 2023 and Looking Ahead to 2024

Success Story

Increasing speed & accuracy of Claims Document Processing for a large Insurance Conglomerate

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Let's make work more human, together.
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