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Seeking Automated Claims Assessment Tool

Background / Description

The Open Innovation Platform (OIP), an initiative by the Info-Communications Media Development Authority of Singapore (IMDA), aims to connect real business challenges to problem solvers. 

 

CONTEXT

SOMPO Insurance Singapore is a member of SOMPO Holdings Inc., a trusted and established Japanese insurance company listed on the Tokyo Stock Exchange. SOMPO has been providing premium and affordable insurance products to individuals and companies in Singapore for the past three decades.

They have a large spectrum of personal insurance products, including travel, medical, and automobile. In line with providing excellent service experience for their clients, personal insurance claims are processed within 3 working days. However, claims assessment is manpower intensive, even for low-complexity claims which forms 40% of all claims. In 2018, SOMPO received 24,200 claims. As an estimate, each low complexity claim would take half an hour, while high complexity claim can take up to 8 hours.

A typical claim process is explained below:
• The customer submits his/her claim to SOMPO via their website, mobile app, or email, providing general information about the claim.
• This can include structured data from website/app, scanned copy of different type of documents or picture of the documents/damage: e.g. Bills, medical reports/memos, Police report, boarding pass, airline letters, birth certificates, photos of the damaged luggage, etc.
• The claim handler will then check the existing system data and the documents submitted.
• Using the defined rules and terms and condition of the insurance policy, the claim handler will decide whether it is payable or not, and how much to pay if applicable.

In general, low complexity claims are defined as claims that requires fewer documents, lower value claim amounts, and fewer rules and conditions to verify before making a decision to pay out the claims or not.

The claims assessment process is manpower intensive and repetitive, and also does not continually challenge the skilled personnel. This situation leads to other challenges such as talent retention and attrition, as well as training of new staff.

As part of its digital transformation journey, SOMPO is looking for digital technology solutions to improve its productivity in claims assessment, automate the low-complexity claim assessment, so as to enable the claim staff to focus on more complex cases to enable faster turnaround times for claim responses and ultimately provide a better customer experience.

 

PROBLEM STATEMENT

How can SOMPO automate claim assessment for low-complexity claims to provide faster service to their customers, and avail trained staff to focus on complex cases?

Technical Specifications

WHAT ARE WE LOOKING FOR
• Proof-of-Concept (POC) solution that automatically check and verify the data and documents submitted and recommend whether the claim is payable and how much to pay based on defined rules
• The solution need to handle English for the POC, but it must be able to extend to other languages such as Chinese, Japanese, Malay, and Thai when solution is fully rolled out
• Cloud-based solutions, if proposed, should be compliant to industry/regulatory standards

 

POSSIBLE USE CASE
(A travel claim is used to illustrate a possible use case, but the tool should not be limited to only travel claims only)

1. Claimant submits their claims to SOMPO via mail, email, SOMPO website, or mobile application
o Claim details: (1) Travel delays, and (2) sick upon returning to Singapore
o Uploads the relevant documents to the portal
o A case number is generated for this claim
o (This phase of the process is currently in place)

2. The automate tool will process the following general steps:
i. Gather data and documents
ii. Assess and extract information
iii. Apply rules and conditions
iv. Make a decision whether to pay and how much to pay.

3. At any point of the automated process, the tool should flag up inconsistencies or anomalies, if any, and route to a skilled staff for further assessment. The system should provide indications on the nature of the anomaly.

 

WHAT’S IN IT FOR YOU
• SGD 25,000 of prize money for each winner of this challenge (see Award Model)
• Opportunity to scale the solution across SOMPO companies in 30 countries worldwide such as Singapore, Thailand, Indonesia, Malaysia, China, India, Turkey, Brazil
• Access to SOMPO’s domain expertise and support for the POC
• Winner will be publicised by SOMPO at the end of the challenge

 

Eligibility

We are open to global and Singapore-based individuals, research providers and companies that have digital technology expertise and innovation capabilities. Some of these include Info-Comm and Media (ICM) start-ups, SMEs and larger companies. Problem Solvers should have the ability and desire to co-create and innovate with Problem Owners or/and other partners to translate their ideas into solutions that can address real business needs. 

There are no restrictions on the geographic location of the problem solvers who may choose to apply to this challenge. However, the POC / prototype needs to be demonstrated in Singapore. Global applicants must be prepared to bear the additional cost of travel.


Further Details

Technical details of the problem statements as well as information related to the innovation calls can be found on the IMDA Open Innovation Platform (OIP) which you will be redirected to after clicking on the 'Proceed To Details' button below and filling up a short form with your basic information.

Preferred Business Model

  • R&D Collaboration
  • Business Collaboration (Joint Venture, Distribution)

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