QualRisk AI - IMPROVING CLAIMS & UNDERWRITING DECISION MAKING WITH GEN AI & MACHINE LEARNING

We are proud to have been selected for cohort 14 of the prestigious Lloyd’s Lab

Did you know 5-10% of commercial insurance losses are avoidable? For the average carrier, that equates to over $20m a year.

Claims adjustors are overwhelmed with complex cases, handling hundreds of documents a day. This leads to errors such as missed subrogation, duplicate payments and coverage creep.

Underwriting teams can overlook submissions and policies which are outside underwriting rules and guidelines, leading to higher claims rates and increased regulatory exposure.

Limited, manual audits, which only review a small percentage of closed claims, submissions or policies at a single point in time fail to recoup losses or catch systemic issues. The processes are resource intensive and inefficient.

It would be ideal if we could audit every claim and policy all the time, but that would be far too resource intensive. With Gen AI that’s about to change.

Introducing our Pulse Product Suite:

Claim Pulse

Portfolio-wide real-time auditing of claims enabling direct remedial action saving $M.

  • Configurable to your Claims Quality Assurance priorities and systems

  • Dashboard to drill-down into specific LOBs, causes and teams

  • Predict claims leakage through our proprietary ML algorithms

  • Communicate directly with adjustors through Gen AI to course-correct in realtime

Underwriting Pulse

Portfolio-wide real-time auditing of submissions and policies enabling direct remedial action, saving $M.

  • UW Rules and Stat guidelines fail rate

  • Email underwriters directly through UI

  • Keep track of AI driven improvements

Rate Filing Pulse

Stay on the pulse of competitor rates through our automated Gen AI driven competitor rate filing’s analysis.

  • Compare rates by different coverage and across different states

  • Identify potential premium gain through adjusting rates

  • Compare to competitors to adjust market position

How does it work?

We transform raw claim, policy, submission and rate filing documents into insights, driving better decisions.

This is achieved by:

  • Extracting comprehensive claim data from unstructured documents, streamlining data capture and improving accuracy.

  • Reducing claim and premium leakage through simulated claim audits, improving operational efficiency and financial control.

  • Identify emerging claim trends and ensure policy compliance across your portfolio for better risk management.

How we do it

QualRiskAI leverages advanced AI and machine learning. We dynamically adapt our products to each client’s unique operational framework.

Through a comprehensive analysis of existing processes, we identify inefficiencies and seamlessly integrate AI-driven automation to enhance accuracy, efficiency, and decision-making.

Our solution is built with a modular architecture, allowing for scalable customization that aligns with business objectives, optimizes workflows, and maximizes cost savings.

By embedding AI into your ecosystem, you will gain intelligent process automation, predictive analytics, and real-time insights, transforming their claims management and risk assessment with cutting-edge technology.