The latest news from EIP for you;
Insurtech EIP has announced the launch of Virtual TPAi, a first-of-its-kind AI tool that offers end-to-end automation of insurance claims processing and decision making.
EIP has built a proprietary voice-led AI agent that performs the role of a third-party administrator (TPA), often referred to as a call centre. The agent, which can handle real life, human-like conversations, is able to answer questions about a customer’s policy and submit a claim for a customer.
The agent can handle up to 20 concurrent conversations, 24 hours a day, seven days a week, the equivalent of approximately 90 human agents. This vastly reduces insurers’ reliance on and costs associated with TPAs.
When processing a claim, the agent submits the information it has gathered from the customer to EIP’s ‘rules engine’ on the back end, where an automated decision is made, either by approving the claim or referring to a human for review.
The use of a rules engine is crucial because it offers clear transparency, human governance and auditability.Unlike typical AI models in which outcomes are based on probabilities and the decision-making process is opaque, EIP’s rules engine is configured by the insurer themselves according to the policy terms. Its decisions are based on 80 “switches” or rules that can be turned on or off by the insurer. As a result, claims decisions are based upon those rules only.
EIP’s rules engine is a tried and tested method of automated claims decisioning, having been in place for over 10 years. The engine has been updated and modernised and the AI agent has been built and placed on the front end to deliver end-to-end automation that improves the overall customer experience.
Where required, a human claims handler can review, override or approve a decision. This human-in-the-loop approach coupled with the auditability of the rules engine’s decision making directly addresses the insurance and AI compliance challenges that the industry has faced when automating claims decisions, a necessarily heavily regulated area. The use of AI systems like this falls under the EU AI Act.
Ross Sinclair, CEO of EIP commented: “After almost a year in development, we are delighted to be launching our Virtual TPAi to support insurers and retailers to leverage the efficiencies that AI has to offer in a compliant way. The AI automation frees up human agents’ time so that they can focus on the more complex claims that require their attention.
The growth potential is huge here because we’ve done the hard work of making sure it works in a regulated environment. We are proud to continue leading the charge on the insurance industry’s adoption of AI in a way that is responsible and human-led, and we look forward to continuing to support clients to transform their operations with our cutting-edge tools.”
David Michell Dawson, Director of Product at EIP commented: “The whole team has worked incredibly hard to deliver something that not only sounds like a real-life conversation, but that augments the end customer’s experience by eliminating waiting times and providing 24/7 support.
“What we were building had to be at least as good as, if not better, than the best customer experience already available today. It needed to reflect the communication channels that customers are comfortable with, which heavily influenced our decision to invest significantly more time and money in the complex process of making the Virtual TPAi voice led. The sophisticated technology behind it makes it impossible for the AI agent to move outside the guardrails we have imposed.”
EIP’s Virtual TPAi process
AI agent handles the conversation and gathers information about a claim.
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Rules engine applies insurer-defined claim decisioning criteria.
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Where required, claims can be referred and a human can review, override or approve.
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The insurer remains accountable for the auditable decision.
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