Dongyang Life Insurance Advances AI Automated Review... "Insurance Payment Within 1 Day"

On the 7th, Dongyang Life Insurance announced that it has completed the advancement and establishment of the insurance claim risk detection system 'CRDS (Claim Risk Detection System)' to expand the automatic review rate and strengthen the response to insurance fraud.

Dongyang Life Insurance, which introduced CRDS in 2011, has been promoting the advancement of CRDS for about 10 months since the end of last year to respond more efficiently to the increasing number of insurance claims and intelligent and organized insurance fraud.

The AI-based automatic review system implemented through this CRDS advancement comprehensively assesses risk factors of insurance claim cases and has dramatically expanded the scope of automatic reviews that do not require separate review procedures. As a result, the automatic review rate for Dongyang Life Insurance’s insurance claims has increased from the early 20% range to 45%. 99% of all insurance claims can now be processed quickly within one day from receipt to review and payment. With faster reviews, the insurance claim payment service for customers is expected to improve significantly. Through AI technology, the system automatically relearns changing claim patterns to maintain a high level of automatic review rate and enables prompt payment of insurance claims to customers even in urgent situations such as the COVID-19 pandemic.

In addition, a system capable of analyzing abnormal signs of insurance fraud from various perspectives such as disease, hospital, doctor, insured, and agent has been introduced, enabling early detection and continuous management of risk groups such as suspected insurance fraudsters. It has also become possible to prevent insurance claim leakage caused by insurance fraud.

For claims requiring review, contract information, claim reasons, previously paid information, and other necessary information at the review stage are provided in a one-stop manner to enable staff in charge to perform their tasks more efficiently.

A Dongyang Life Insurance official stated, “We carried out the insurance claim risk detection system advancement project to actively respond to the increasing accident insurance claims and organized and intelligent insurance fraud that leads to premium increases for honest policyholders. We expect to provide better customer service through this CRDS advancement, which implements proactive insurance fraud prevention and efficient review operations.”