Rudolph’s got a runny red nose?
Santa gets same-day reimbursement for vet bills with Clive AI’s straight through processing
Five Sigma’s Clive™ AI Brings Straight-Through-Processing to Pet Insurance Claims, Reducing Handling Time by Over 90%
New York City, December 26, 2024 – Five Sigma, an innovative Insurtech pioneering AI-native claims management, unveiled today a game-changing advancement that fully automates pet insurance claims handling. Using Clive™, Five Sigma’s AI Claims Adjuster, the company enables pet insurers to process claims with Straight-Through Processing (STP), reducing claim cycle times drastically by over 90%, minimizing costly errors, and improving customer satisfaction to new heights.
The Challenges of Manual Pet Insurance Invoice Processing
Handling veterinary invoices in pet insurance is a daunting task, involving detailed and often coded line items that adjusters must interpret under tight deadlines to initiate and adjudicate a claim.
Each vet bill requires meticulous cross-referencing with the pet insurer’s policy terms to determine coverage eligibility and deductibles, a manual process that takes a long time, and is prone to human errors and delays. Such errors can lead to claims leakage and financial losses, and potentially deteriorate customer trust.
Automating Claims Handling with Clive™, the Insurance Industry’s AI Claims Adjuster
Five Sigma now uses its recently released AI Claims Adjuster, Clive™, to handle this challenge and offer a new solution for Straight-Through-Processing (STP) of pet insurance claims.
Clive is Five Sigma’s AI Claims Adjuster, an artificial intelligence agent designed to enhance claims processing by automating time-consuming tasks and by providing adjusters with data-driven recommendations and insights. Clive leverages AI technology to streamline workflows, reduce manual tasks, and improve decision-making, enabling adjusters to focus on complex cases and customer service. Clive integrates seamlessly with any claims management system (CMS), adding AI capabilities and automation to older systems, thereby improving efficiency, accuracy, and policyholder satisfaction.
By implementing insurance best practices and adhering to insurer-specific Standard Operating Procedures (SOPs), Clive automates pet insurance claims handling, and can allow STP processing under defined criteria.
How Clive Streamlines Pet Insurance Claims Management
Clive’s STP processing can reduce handling time dramatically, lower pet insurers’ Loss Adjustment Expenses (LAE), and increase customer satisfaction. Here’s how Clive streamlines the pets insurance claims process:
- Recognizing Invoices for Payment – Clive identifies invoices and vet bills coming in from policyholders through digital channels, analyzes their validity as well as all line items for various treatments and services. Clive also compares invoice details against historical claims data for contextual accuracy.
- Verifying Coverage – Clive checks the claimant’s pet insurance policy details, verifying coverage eligibility, limits, and deductibles. If there’s no coverage at all or an exception applies, Clive suggests to decline the claim, and suggests the language to explain the decision to the adjuster who will be tasked with such notification.
- Mapping and Matching Claim to Policy – Clive categorizes the invoice’s line items according to appropriate expense types and matches the expenses with the claimant’s specific policy, coverage, limits, deductibles, and taxes. Clive makes a coverage mapping and decision for each line item in the submitted invoice. Automatically entering the invoiced expenses to the claims management system also reduces all human errors that are common in the manual way of executing this step, where adjusters need to flip documents and systems and quickly type small invoice digits into the CMS.
- Quality Control and Fraud Detection – While analyzing, Clive also checks for anomalies or inconsistencies that might be indicative of fraud, and flags claims that require additional scrutiny for human adjusters’ review.
- Financial Calculation and Payment – For claims that fall within predefined criteria, Clive can approve the claim, calculate the reimbursement that is due, given past claims, deductibles, and taxes, and execute the payment.
- Fallback to Manual Processing in Complex Cases – For cases requiring human judgment, Clive acts as a digital assistant, flagging anomalies for manual review while documenting its analysis. This hybrid approach ensures both speed and accuracy without sacrificing oversight. If a claim does not meet the criteria for STP, or flagged by Clive for any exception or suspicion, Clive documents the findings and reasoning, and passes the claim for manual processing. This way, the majority of claims are handled automatically with no human intervention while adjusters focus on the more complex cases that require a closer analysis and adjudication.
“Automation is no longer a dream about the future of claims management; it’s here and available, on top of any existing Claims Management System (CMS). With Clive AI, we’re setting a new standard for efficiency in pet insurance, as part of a larger revolution for how P&C claims are handled across the entire industry. Clive is the most seasoned and careful adjuster – paying attention to both insurers’ SOP and the specifics of each claim. Generative AI, coupled with our claims know-how, enables us at Five Sigma to realize benefits that were considered utopian fantasies up until now,” said Oded Barak, CEO and Co-Founder of Five Sigma.
Clive AI and the Five Sigma team wish you a Merry and Healthy Christmas!