A life and annuity (L&A) insurance service staff (policy administration or claims) serves as a critical intermediary between policyholders and insurance companies. Their role involves policy maintenance, investigating claims, assessing impact, and ensuring that settlements are processed fairly and promptly.
To transform an L&A service staff into a “superpowered” professional, disruptive technologies would enhance efficiency and accuracy, empower staff with the ability to get the job done, and ultimately improve customer satisfaction.
Below is a snapshot of a typical day for a service staff with SUPERPOWERS (i.e., good data, automation, and an AI assistant):
See also: A Season of Change for Life Insurance and Annuities
Human in the Loop Work Orchestration:
- Review personalized dashboard on critical items needing attention.
- Respond to overnight emails and messages from policyholders, internal departments, or other external stakeholders in your enterprise workflow solution. Update any notes or set any reminders.
- Review and start working on pending/new cases that are automatically prioritized and routed based on deadlines, severity, or complexity.
- Analyze insurance policy information and document summaries to understand eligibility, request type compared with policy information such as coverage limits and exclusions for new requests in one user interface. Contact policyholders via their communication choice if additional information is required.
- Handle urgent requests or disputes that may require immediate attention.
- Update policyholders/stakeholders on progress and resolve questions or concerns per communication choice of their choosing. Handle disputes or escalations when stakeholders disagree with assessments or coverage decisions, using facts and empathy as data surrounding the decision is in one interface.
- Submit for approvals/denials based on authority limits
- Review and adjust ad hoc letters for any complaint/denials/complex workflows. The correspondence engine automatically provides a recommended language based on the action.
- Review payout calculations that need oversight due to the size and nature of the request. The calculation logic is presented for review and approval.
Agentic Workflows (Superpowers) in Action
- Natural Language Processing (NLP): Real-time, multilingual customer interaction and document interpretation. NLP tools like chatbots and voice assistants handle policyholder queries, extract key data from documents such as medical records or death certificates, and summarize complex documents, ensuring faster resolution.
- AI-Enabled Workflow Automation: Lightning-fast processing aimed to un-fragment various solutions into one experience. With agentic flows, repetitive tasks such as checking eligibility, retrieving and summarizing required documents, and initiating payouts are automatically done, which reduces human error and processing time.
- AI-Driven Triage: Instantaneous work categorization, prioritization, and routing of work. AI models analyze request details, policyholder history, policy information, and third-party data to recommend next steps, flagging fraudulent activity and urgent payouts.
- Third-Party Data Integration: Access to real-time data from various sources to retrieve meta data or specific info such as death data. Service staff leverage data from these data sources to validate events (e.g., accidents or health conditions) and expedite processing.
- Quantum Computing Insights: Instant risk assessment and fraud detection. Quantum computing processes complex datasets to identify fraud patterns or optimize payout models faster than traditional systems.
- Hyper-Personalization With AI: Tailored customer experiences and communication. AI analyzes policyholder demographics, behavior, and preferences to customize communication and processes, enhancing satisfaction.
- Sentimental Analysis for Empathetic Support: Detecting emotional states for tailored communication. AI models evaluate a stakeholder’s tone, language, and sentiment during interactions, helping staff respond empathetically while managing expectations.
- Advanced Analytics and Insights: Data-driven decision-making. Predictive analytics tools identify trends in requests, uncover potential risks, and suggest ways to enhance underwriting or streamline future processing.
See also: AI Bias in Life & Annuities Insurance
By blending these technologies, the L&A service staff becomes not just a processor but a proactive problem solver, delivering exceptional service while minimizing inefficiencies and errors.
At carriers that adopt these technologies, operations staff can focus on more complex, human-centered aspects of their roles while ensuring accuracy, consistency, and efficiency in handling work, providing a personalized customer experience.
