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VPay Leadership Series: The Future of Claims Interaction

In this episode, thought leaders from, Mastercard, and OptumFinancial explore the latest innovations in insurance, including drones, big data, the internet of things (IOT), and artificial intelligence.

Recently, VPay hosted the second entry in our ongoing series of discussions with insurtech and fintech leaders, focusing on the topic The Future of Claims Interactions. For this conversation, our host — Bryan Falchuk, Managing Partner of Insurance Evolution Partners — was joined by:

  • Patti Harmon – Editor-in-Chief at Claims Magazine and
  • Girish Panday – Chief Product Officer at Optum Financial
  • Beth Griffin – Vice President, Security Innovation Healthcare Vertical / Cyber & Intelligence at Mastercard


watch the full discussion

“[Policyholders] want that almost instantaneous delivery of service, while being kept abreast of how a claim is traveling through the process and, most importantly, when and how it will be paid.”

—Patti Harmon, Editor in Chief at Claims Magazine and

Early in the conversation, Harmon identifies how the response to claims is changing for carriers at the same time expectations are changing for policyholders. Technology is making it easier for carriers to quickly and easily identify complex or high-risk claims earlier in the process — and, by proxy, to identify simpler claims that can be automated. Resolving these simpler claims more quickly makes policyholders happier and saves money for carriers.

On the product side, Girish Panday suggested that the technologies to automate these claims are expected to surface fully within the next few years, with near-complete implementation occurring before the end of the decade. And Beth added that the great challenge in automating claims is security — verifying that payees are who they say they are, and claims are not fraudulent.

“The claims payment … is typically the most impactful experience for policy members in terms of loyalty and retention.”

—Girish Panday, Chief Product Officer at Optum Financial

While the insurance industry is dramatically different from more consumer driven industries (e.g., retail, finance, tech, etc.), Panday points out that policyholders will still demand the same ease of interaction those other industries are achieving. In fact, the amount of support required by policyholders during a claim will often demand even more transparency and insight into the claim’s status. And the communications around this claims process will need to be tailored to the claimant, with Baby Boomers, Gen-X, Millennials, and Gen-Z all desiring different ways of interacting with insurers.

Panday also predicts that the claims payment process will need to evolve such that policy holders — especially those in the health care space — no longer need to make payments to multiple providers. Instead, they will receive a single, consolidated bill for all their expenses related to an episode.

Harmon adds that payments made out to policyholders will need to transition to various digital payment options. Payment is the last step in the claims process, leaving the greatest impression on the claimant, and paper checks delivered by mail dramatically lower customer satisfaction.

The most important change coming through touchless claims advancements will be the speed at which claims are processed. Smart cars will automatically report collisions to both first responders and carriers as soon as they occur. Drones will be able to quickly survey a disaster area before it would be safe for adjusters, then let carriers know the scale of the event. And AI will triage claims in moments, resolving smaller scale claims and issuing payment in hours instead of weeks.

On the health care side, AI will give providers near immediate insight into how diagnoses are covered by payers, helping providers avoid exception processes that require human analysis and approval.

“We can drive more efficiency by using artificial intelligence to be able to identify fraudulent activity more quickly — even bring it up potentially to the prepayment side of things so it can be stopped in its tracks and managed.”

—Beth Griffin, Vice President, Security Innovation Healthcare Vertical / Cyber & Intelligence at Mastercard

Beth Griffin noted that AI has been used in the financial services space for nearly 20 years now, analyzing transactions and providing feedback on potential cases of fraud. That technology has now advanced such that feedback is provided in real time, often manifesting as text messages to account holders when transactions appear to be fraudulent.

These technologies are now being implemented within payers, specifically in the health care space, to identify cases of fraud. This fraud reduction will obviously save costs for insurers, but more importantly will save costs for patients and policyholders who end up taking on the costs of fraudulent or abusive activity that can increase costs.

The cost of investigating abusive activity is massive. But implementing machine learning trained on previously investigated cases reduce the time it takes to investigate, eventually identifying instances of claims fraud in real time, before payment has been issued.

>> Watch the full discussion now

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