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How can Artificial Intelligence settle Insurance Claims in five minutes?

Originally published on medium.com

If you’ve ever been in the position of having to file an insurance claim, you would agree that it isn’t the most pleasant experience that you’ve likely ever encountered.

In fact, according to J.D. Power’s 2018 Insurance Customer Satisfaction Studymanaging time expectations is the key driver of satisfaction — meaning, a prompt claim settlement is still the best advertisable punch line for insurance firms. Time-to-settle satisfaction ratings were found to be 1.9 points lower even when the time frame was relatively short and insurers still missed customer timing expectations.

So what should an established insurance company do, to be at par with the customer’s desires of modern service standards? The question becomes even more pertinent when the insurance sector is still lagging behind consumer internet giants like Amazon, Uber who are creating newer levels of customer expectation. Lemonade, MetroMile and others are already taking significant market share away from traditional insurance carriers by facilitating experiences that were previously unheard of in the insurance trade.

Today, Lemonade contends that with AI, it has settled a claim in just 3 seconds! While a new era of claims settlement benchmarks are being set with AI, the industry is shifting their attitude towards embracing the real potential of intelligent technologies that can shave-off valuable time and money from the firm’s bottom-line.

How AI integrates across the Insurance Claims Life Cycle

For this entire process to materialize — from the customer filling out the claim information online, to receiving the amount in a bank account within a short amount of time, and have the entire process be completely automated without any interference, bias, or the whims of human prejudice.

How does this come about? How does a system understand large volumes of information that requires subjective, human-like interpretation?

The answer lies within the cognitive abilities of AI systems.

For some insurers the thought that readily comes to mind is — Surely, it must be quite difficult to achieve this in real-world scenarios. Well, the answer is — NO, it isn’t!

Indeed, there are numerous examples of real-world cases that have already been implemented or are presently in use. To understand how these systems work, we need to break down the entire process into multiple steps, and see how each step is using AI and then passing over the control to the next step for further processing.

How It Works
For the AI-enabled health insurance claims cycle, there are a few distinct steps in the entire process.

Analysis and abstraction

The following information is first extracted from medical documents (diagnosis reports, admission & discharge summaries etc.)

  1. Cause, manifestation, location, severity, encounter, and type of injury or disease — along with & related ICD Codes for injury or disease in textual format.
  2. CPT Codes — procedures or service performed on a patient, are also extracted.

There are in essence two different systems. The first one (described above) processes the information that is presented to it, while the other looks from the angle of genuineness of the information. The latter is the fraud detection system (Fraud, Abuse & Wastage Analyzer) that goes into critical examination of claim documents from the fraud, abuse and wastage perspective.

Fraud, Abuse & Wastage Analyzer

Insurance companies audit about 10% of their total claims. Out of which around 4–5% are found to be illegitimate. But the problem is that the results of these audit findings are available much after the claim has been settled, following which recovering back the money already paid for unsustainable claims is not that easy.

This means that companies are losing big sums on fraudulent claims. But is there a way by which insurers can sniff out fraud in real time while the claim is under processing?

With Cognitive AI technologies available today, this is achievable. All you need is a system that analyses hundreds and thousands of combinations of symptoms, diagnoses and comes up with possible suggested treatments. The suggestions are based on the learnings from past instances of cases that has been exposed to the AI system.

The suggested treatments’ tentative cost — based on the location, hospital, etc., is compared with the actual cost of the treatment. If the difference suggests an anomaly, then the case is flagged for review.

Automated processing of medical invoices

Now if your Fraud Analyzer finds no problem with a claim, how can you expedite its processing? Processing requires gathering information from all medical invoices, categorizing them into benefit buckets, and then finalizing the amount allowed under each head. Advanced systems can automate this entire process, ruling out manual intervention in most of these cases.

Recent AI systems have the capability of extracting line items from a scanned medical invoice image. This is achieved through a multistep process, outlined below.

  1. Localizing text on the medical invoice. This gives the bounding boxes around all texts.
  2. Running all localized boxes against a Scene Text Decoder trained using a LSTM and a Sequence Neural network.
  3. Applying Levenshtein Distance Correction for better accuracy.
  4. Mapping each line item against an insurer specific category.

Each line item is iterated over and looked up against the policy limits to get its upper limit. Each line item amount is aggregated to finally get the final settlement amount.

If the final settlement amount is within the limits set for straight through processing and no flags are raised by the Fraud, Abuse & Wastage Analyzer, then the claim is sent to billing for processing.

Moving Ahead With AI Enabled Claims
Today, AI transforms the insurance claims cycle with greater accuracy, speed and productivity, at a fraction of the cost (in the long run) — while delivering enhanced decision making capabilities and a superior experience in customer service. While, in the past, these innovations were overlooked and undervalued for the impact they produced — the insurers of today need to identify the proper use cases that match their organization’s needs and the significant value they can deliver to the customers of tomorrow. The cardinal rule is to — start small through feasible pilots, that will first bring lost dividends back into the organization.


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Smart Machines & Smarter Humans: AI in the Manufacturing Industry

We have all witnessed Industrial Revolutions reshape manufacturing, not just once, but multiple times throughout history. Yet perhaps “revolution” isn’t quite the right word. These were transitions, careful orchestrations of human adaptation, and technological advancement. From hand production to machine tools, from steam power to assembly lines, each transition proved something remarkable: as machines evolved, human capabilities expanded rather than diminished.

Take the First Industrial Revolution, where the shift from manual production to machinery didn’t replace craftsmen, it transformed them into skilled machine operators. The steam engine didn’t eliminate jobs; it created entirely new categories of work. When chemical manufacturing processes emerged, they didn’t displace workers; they birthed manufacturing job roles. With each advancement, the workforce didn’t shrink—it evolved, adapted, and ultimately thrived.

Today, we’re witnessing another manufacturing transformation on factory floors worldwide. But unlike the mechanical transformations of the past, this one is digital, driven by artificial intelligence(AI) working alongside human expertise. Just as our predecessors didn’t simply survive the mechanical revolution but mastered it, today’s workforce isn’t being replaced by AI in manufacturing,  they’re becoming AI conductors, orchestrating a symphony of smart machines, industrial IoT (IIoT), and intelligent automation that amplify human productivity in ways the steam engine’s inventors could never have imagined.

Let’s explore how this new breed of human-AI collaboration is reshaping manufacturing, making work not just smarter, but fundamentally more human. 

Tools and Techniques Enhancing Workforce Productivity

1. Augmented Reality: Bringing Instructions to Life

AI-powered augmented reality (AR) is revolutionizing assembly lines, equipment, and maintenance on factory floors. Imagine a technician troubleshooting complex machinery while wearing AR glasses that overlay real-time instructions. Microsoft HoloLens merges physical environments with AI-driven digital overlays, providing immersive step-by-step guidance. Meanwhile, PTC Vuforia’s AR solutions offer comprehensive real-time guidance and expert support by visualizing machine components and manufacturing processes. Ford’s AI-driven AR applications of HoloLens have cut design errors and improved assembly efficiency, making smart manufacturing more precise and faster.

2. Vision-Based Quality Control: Flawless Production Lines

Identifying minute defects on fast-moving production lines is nearly impossible for the human eye, but AI-driven computer vision systems are revolutionizing quality control in manufacturing. Landing AI customizes AI defect detection models to identify irregularities unique to a factory’s production environment, while Cognex’s high-speed image recognition solutions achieve up to 99.9% defect detection accuracy. With these AI-powered quality control tools, manufacturers have reduced inspection time by 70%, improving the overall product quality without halting production lines.

3. Digital Twins: Simulating the Factory in Real Time

Digital twins—virtual replicas of physical assets are transforming real-time monitoring and operational efficiency. Siemens MindSphere provides a cloud-based AI platform that connects factory equipment for real-time data analytics and actionable insights. GE Digital’s Predix enables predictive maintenance by simulating different scenarios to identify potential failures before they happen. By leveraging AI-driven digital twins, industries have reported a 20% reduction in downtime, with the global digital twin market projected to grow at a CAGR of 61.3% by 2028

4. Human-Machine Interfaces: Intuitive Control Panels

Traditional control panels are being replaced by intuitive AI-powered human-machine interfaces (HMIs) which simplify machine operations and predictive maintenance. Rockwell Automation’s FactoryTalk uses AI analytics to provide real-time performance analytics, allowing operators to anticipate machine malfunctions and optimize operations. Schneider Electric’s EcoStruxure incorporates predictive analytics to simplify maintenance schedules and improve decision-making.

5. Generative AI: Crafting Smarter Factory Layouts

Generative AI is transforming factory layout planning by turning it into a data-driven process. Autodesk Fusion 360 Generative Design evaluates thousands of layout configurations to determine the best possible arrangement based on production constraints. This allows manufacturers to visualize and select the most efficient setup, which has led to a 40% improvement in space utilization and a 25% reduction in material waste. By simulating layouts, manufacturers can boost productivity, efficiency and worker safety.

6. Wearable AI Devices: Hands-Free Assistance

Wearable AI devices are becoming essential tools for enhancing worker safety and efficiency on the factory floor. DAQRI smart helmets provide workers with real-time information and alerts, while RealWear HMT-1 offers voice-controlled access to data and maintenance instructions. These AI-integrated wearable devices are transforming the way workers interact with machinery, boosting productivity by 20% and reducing machine downtime by 25%.

7. Conversational AI: Simplifying Operations with Voice Commands

Conversational AI is simplifying factory operations with natural language processing (NLP), allowing workers to request updates, check machine status, and adjust schedules using voice commands. IBM Watson Assistant and AWS AI services make these interactions seamless by providing real-time insights. Factories have seen a reduction in response time for operational queries thanks to these tools, with IBM Watson helping streamline machine monitoring and decision-making processes.

Conclusion: The Future of Manufacturing Is Here

Every industrial revolution has sparked the same fear, machines will take over. But history tells a different story. With every technological leap, humans haven’t been replaced; they’ve adapted, evolved, and found new ways to work smarter. AI is no different. It’s not here to take over; it’s here to assist, making factories faster, safer, and more productive than ever.

From AR-powered guidance to AI-driven quality control, the factory floor is no longer just about machinery, it’s about collaboration between human expertise and intelligent systems. And at Mantra Labs, we’re diving deep into this transformation, helping businesses unlock the true potential of AI in manufacturing.

Want to see how AI-powered Augmented Reality is revolutionizing the manufacturing industry? Stay tuned for our next blog, where we’ll explore how AI in AR is reshaping assembly, troubleshooting, and worker training—one digital overlay at a time.

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