A Brief Overview

Our Customer, a trusted name in Auto Insurance for over four decades provides collision and comprehensive Insurance for individuals and organizations. It embarked on its transformative journey in 2019 by adopting cloud technologies.

Despite its strong reputation and a loyal customer base, the customer found itself grappling with the age-old challenge in an area that has long plagued the insurance sector — efficient claims processing. The complexities, inefficiencies, and customer dissatisfaction stemming from their existing claims processing led them to partner with us.

Agile Soft Systems addressed the challenges the customer faced, and positioned the organization as a forward-thinking player in an extremely competitive and ever-evolving industry.

This case study offers insights for Insurance companies seeking similar transformations, re-iterating the power of application modernization in reshaping established operations.

Challenges Faced in Claims Processing

Auto insurance claims processing is a critical function within the insurance industry. The customer was riddled with several complex challenges they had to navigate:

• Diverse Claim Types: Auto insurance encompasses a wide range of claims, from minor accidents to major collisions, theft, vandalism, and natural disasters. Each claim type requires unique assessment and handling procedures.
• Complexity of Assessments: Assessing auto damage and determining liability was complex, especially in multi-vehicle accidents or cases involving uninsured or underinsured drivers.
• Data Accuracy and Fraud Detection: It’s critical to ensure that the information provided by the claimant is accurate. Any inconsistencies in the information could lead to delays, disputes and processing of fraudulent claims that cost the insurer heftily. the customer had implemented technology in some areas of advanced fraud detection but had not carried out the work to full extent.
• Claims Volume and Seasonality: The client frequently encountered fluctuations in claim volume due to factors like weather-related incidents and holiday travel season. Handling these surges efficiently was a huge challenge.
• Regulatory Compliance: Auto insurance claims must adhere to a plethora of regulations, which vary by location. As Trandland Insurance operated in several states, staying compliant while streamlining processes was not easily manageable.

Technological Challenges Faced in Claims Processing

• Partial Technology Adoption: Though the customer had migrated their applications to the Cloud, they were not leveraging modern technologies to its full potential. The implementation of DevOps was inefficient and not well-executed. and their existing User Experience was weak, hindering seamless customer interactions.
• Customer Experience: Customers expect fast and easy claims processing. Additionally, it is essential to communicate with claimants effectively. Keeping them updated on the state of their claims and the following steps they ought to take promotes loyalty and builds trust.The customer found itself in a situation where they had closely imitated the user experience and interfaces of other insurance companies, which had led them to encounter similar issues as those companies.
• Data Security: Safeguarding sensitive customer information throughout the claims process is vital, especially in light of growing worries about privacy violations and data breaches. While no significant data security incidents were reported, Agile Soft Systems stressed the need to prioritize security and integrate it seamlessly into the development processes.

Solutions to Streamlined Claims Processing

Agile Soft Systems first thoroughly assessed and documented the existing systems they had in place. Then two Design Thinking workshops were conducted following the project initiation— one to redesign the flow of the existing system and enhance the process for the client, the customer, and the second workshop to audit the user experience for the claimants.

Here is a breakdown of how Agile Soft Systems successfully solved each problem related to claims processing for the client.

1. Diverse Claim Types and Complexity of Assessments:

a. Claim Type Routing

Agile Soft Systems implemented a microservices architecture to break down the monolithic claims processing system into specialized services. These microservices are designed to handle specific claim types, such as minor accidents, major collisions, theft, vandalism, or natural disasters.

Further AI and Predictive Analytics are used to route the claims to its appropriate microservice to streamline assessment and handling procedures.

b. Damage Assessment

The AI and ML algorithms were implemented to assist in assessment of auto damage and to analyze images of vehicle damage to estimate repair costs and severity. Additional factors like vehicle age and make are also included to help adjusters make more accurate assessments.

2. Data Accuracy and Fraud Detection

Agile Soft Systems used data analytics and machine learning algorithms to analyze large datasets of historical claims. These algorithms are used to identify patterns, anomalies that suggest fraud. They also assess claimant behavior against historical records.

Agile Soft Systems implemented image and video analysis to validate the authenticity of photos and videos submitted as evidence by the claimants. This helps to verify the extent of damage and the circumstances of an accident.

We also included Geo Spatial analysis to help insurers identify suspicious claims based on the location of accidents, repair shops, and medical facilities. Unusual travel patterns or clustering of claims in a specific area is now flagged by the system prompting the customer to investigate further.

Also recurring scenarios like staged accidents or inflated property damage claims are detected and flagged by the system.

3. Claims Volume and Seasonality:

Agile Soft Systems leveraged cloud-based scalability to handle fluctuations in claim volumes. AI Ops tools are used to monitor system performance and allocate resources dynamically. Additionally predictive analytics is used to forecast claim volume trends based on historical data, to aid in resource allocation planning during peak seasons.

4. User Experience

Our UX team conducted a successful Design Thinking workshop before redesigning the client's and claimant's facing interfaces. AI Chatbots were implemented to attend to initial claimant queries.

A microfrontend architecture was implemented. This enabled us to independently develop and deploy UI components to client and claimant facing interfaces. This also helped us to make incremental updates and to run A/B tests efficiently when it was required.

The claimant-facing interface now boasts a screen where the progress of the claims process can be viewed, leading to increased transparency in the system and higher customer satisfaction. Claimants can also opt to receive notifications for updates on the progress.

5. Regulatory Compliance and Data Security:

Agile Soft Systems Implemented DevSecOps practices to automate compliance checks and validations as part of the development and deployment process. Additionally, microservices architecture gave us the flexibility to adapt to different state-specific regulations. Each microservice is configured to adhere to the specific compliance requirements of the state in which it operates, ensuring regulatory compliance.

Agile Soft Systems implemented security automation practices as part of DevSecOps. This includes encryption of sensitive customer data, strict access controls, and regular security audits. By integrating security into the development pipeline, data security is prioritized throughout the claims processing system.

By leveraging the power of DevSecOps, UX, Microservices, Microfrontend, AI and ML, Agile Soft Systems was able to modernize the customer's claims processing system to enhance efficiency, customer satisfaction, compliance, and security.

Enhancing Insurance Operations Through Holistic Transformation

By embracing Design Thinking, DevOps practices, UX practices and Microservices architecture, the customer successfully addressed long-standing challenges in the insurance industry.

The outcomes are clear: simpler procedures, quicker processing times for claims, fewer errors, and, perhaps most important, higher levels of customer satisfaction.

The core of the customer's and Agile Soft Systems' success lies in its holistic approach to application modernization. By integrating Design Thinking methodologies to empathize with customers, DevOps practices to enhance collaboration and efficiency in software delivery, and Microservices architecture to enable agility and scalability, we achieved a comprehensive transformation.

This approach serves as a blueprint for auto insurance companies and organizations in other sectors looking to modernize their operations. It highlights that integrating the newest technologies is important, but that successful modernisation also involves reinventing procedures, encouraging creativity, and adopting a customer-centric approach.