Claims Automation

Daisy implemented two of its solutions during this trial to meet our client’s objectives.

• Daisy Claims Automation: Automated claim adjudication system for in-process claims.
• Daisy Fraud Detection: Automated fraud detection system that would identify potential fraud for in-process claims.

A typical Daisy implementation requires 2 months to onboard the client’s data and to work with the business operators to understand the client’s existing process and capabilities in claims processing.

To achieve the client’s claims cost reduction goals, Daisy’s system was integrated into the client’s robotic process automation (RPA) capabilities to permit straight-through processing. The RPA tools would either straight-through process a claim based on Daisy’s recommendation for payment, recommend denial of a claim due to suspected fraud, recommend partial claim payment, or recommend standard processing with human intervention required.

The Daisy recommendations were delivered in the form of the Daisy Payment Index for straight-through processing or the Daisy Suspicion Index for fraud detection. Using the combination of the Daisy system’s autonomous recommendation, claim materiality, and claim complexity, the clients RPA system would process the claim accordingly. A daily cycle of receiving in-process claims with a three hour turnaround from the Daisy system back to our clients RPA system was implemented during the trial.