DeepClaims

DeepClaims analyzes claim histories to detect anomalies, protecting your business.

• Cross-references customer history with external databases.
• Highlights suspicious patterns in claims documentation.
• Identifies duplicate or overlapping claims.
• Monitors claim amounts and triggers alerts for unusually high values.
• Utilizes machine learning to adapt fraud detection models over time.
• Generates detailed fraud investigation reports.

Areas impacted include: Claims, Underwriting, Compliance, Legal, Commercial, Customer Service, Finance, Providers, and more.

• Increased speed in closing massive claims.
• Automated Fast-Track claims management (100%).
• Analysis of average costs and detection of deviations.
• Automatic reading and interpretation of invoices, images, and related documents in any language.
• Real-time updates of claim reserves.
• Change in claims management philosophy (managing adjuster’s schedule vs. current email inbox approach).
• Automatic calculation of damage values to determine compensation or referral to Technical Services.

• They analyze the extent of damages covered by the policy, according to the product’s General Conditions and Particular/Special Conditions, identifying coverage and exclusions related to the claim, reducing human errors.
• They determine and update the claim reserve based on the scope of the claim and the documentation provided by the insured.
• They identify third parties responsible in order to facilitate recovery after or during the claim management.
• They analyze possible fraud following different parameters (images, claim reports, surveyor notes, appraiser input, and claims history).
• They evaluate and update the average claim costs in line with the company’s interests.

• Review of survey reports vs. Particular Conditions – General Conditions (Consortium-eligible meteorological damages).
• Location of statements, interpretation of liability, and profitability calculation (CICOS modules).
• Analysis of home-claim invoices vs. Assistance Companies’ fee schedule (Provider Control).
• Management of electrical damage claims (compensation vs. repair analysis).
• Management of mechanical warranty claims (analysis of claim documentation).
• Third-party claim process for identified personal and/or material damages (Recourse).
• Management of consortium-eligible damages (DANA).
• Management of Travel Assistance claims.
• Analysis of legal claims.
• Management of the email inbox (analysis of documentation, coverage, and valuation).

Also covering: Analysis of average costs / Reserves / Frequently used guarantees / Fraud

15,000 Claims in 72 Hours – DANA Valencia

• DANA Valencia

Scope: Massive analysis of premium payments, policies, the situation of insured risks, and the collection of bank account data for CCS payouts.

7,500 Meteorological Claims Processed

• Meteorological Damages

Scope: Analysis of surveyor reports for meteorological damage claims caused by water, wind, hail, and/or snow.

6,500 Claims Analyzed

• Personal Injury Claims
• Class Action

Scope: Analysis of medical reports, exam results, surgeries performed, implant labels, and other documents.

• Analysis of average costs and detection of provider deviations and comparisons.
• Control of average turnaround times in derived services.
• Compliance control in the area (supplier contracts and regulatory compliance).
• Control of fraud arising from claims management (analysis of submitted invoices).
• Control of billing deviations vs. the assistance company's fee schedule.

• Analysis of average claim costs by line/product/coverage.
• Analysis of main coverages with the highest claim frequency.
• 100% omnichannel management of new production underwriting (WhatsApp + AI).
• Automatic reading and interpretation of relevant documents for coverage determination in lines/products that require documentation analysis.
• Control of the policy portfolio signed by the insured in the insurance company’s DB.
• Control of clauses outside the underwriting rules in the active portfolio history.

• Control of clauses outside underwriting rules in the active portfolio history.
• Control/analysis of technology provider contracts to comply with DORA regulations.
• Control of the policy portfolio signed by insured parties in the company’s DB.
• GDPR control regarding the use of AI in a secure environment (the company’s own instance).

• Improved SLAs through automated email inbox management with AI.
• 100% omnichannel customer service (WhatsApp + AI).
• Reduction of calls and expansion of 24h/365d service without referring to external providers.
• Predictive NPS analysis.

• Real-time control of updated reserves.
• Real-time control of CICOS modules (debtor/creditor) to view balances.