AI Can Be a Powerful Tool for Insurance Compliance

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3 minute read

Insurance is one of the world’s most heavily regulated industries. It isn’t easy to keep an enterprise in compliance with the constantly changing patchwork of federal and state regulations. Fortunately, intelligent solutions like Amelia AIOps (formerly 1Desk) and Amelia can be a powerful tool in this regard.

Insurance is one of the world’s most heavily regulated industries. Compliance officers within the industry are forced to contend with a constantly evolving collage of federal and state regulations. Fortunately, Artificial Intelligence (AI) can help manage the often-chaotic world of enterprise-scale compliance. By tapping into the power of autonomic frameworks like AIOps and cognitive agents like Amelia, businesses can nimbly react to changing regulatory environments.

Flexibility at Scale

When Amelia is hired to automate the User Experience (UX), customers benefit through 24/7 omnichannel accessibility, hyper-personalized experiences and the ability to resolve issues with limited-to-no human intermediation. This same automation can benefit providers through the power of scaled flexibility, and that includes areas such as compliance.

As new insurance regulations come into effect, Amelia empowers enterprises to tweak customer journeys in order to remain in compliance — steps can easily be added/deleted/edited from any point along a business process. Similarly, compliance changes can easily be applied to back-office processes through AIOps' autonomic framework.

When security compliance tasks are automated for insurance carriers by machines, human compliance and security teams are freed to address complex or unique needs to safeguard their companies and their customers.

Once changes are implemented, they can be instantly available all around the world. This is a far more efficient means to adopting new processes at scale than the pre-automation era, which depended on human intermediation. In this non-AI scenario (which is still the norm for many insurance carriers), various teams around the world would have to be educated on new protocols, which could result in a significant lag on implementing changes, as well as a drag on productivity and the overall business. Now changes can come into effect with a few commands that are automated and disseminated throughout an organization.

Furthermore, AIOps and Amelia are able to target compliance initiatives to individual customers and scenarios. For example, California requires an acknowledgement of all auto insurance claims within 15 days. So in this case, once the system recognizes that a customer residing in a California zip code has submitted a claim, the system could be designed to automatically email (or mail) the customer an acknowledgment of receipt of the claim. This wouldn’t necessarily be the case for a customer in other states who have no such regulation.

Real-Time Alerts, Automated Investigations

When both the UX and back-office insurance processes are automated, it can enable real-time alerts, which can catch and address issues before further damage ensues. These real-time reactions don’t only make good business sense; they may be necessary for compliance.

For example, Federal Anti-Money Laundering (AML) regulations include a number of stringent rules designed to stamp out fraud and other criminal activity, and it is increasingly relevant to many insurance products as well. AIOps can alert the compliance team responsible for overseeing the AML program about suspicious activity. Since many tasks related to researching and resolving AML alerts are highly-regimented, they can be automated through AI solutions. These investigations can also be used as the basis for automatic generation and filing of Suspicious Activity Reports (SARs), an important part of AML compliance. In the event that an account or payout is mistakenly frozen as part of an AML investigation, AI can be useful to quickly confirm legitimacy so customers can regain access in a timely manner.

Similarly, real-time alerts and automated investigations can also keep insurance companies in compliance with evolving data-breach and data-security regulations. Since every step from the front- to back-office can be handled by machines, there is a clear record of all transactions. Furthermore, AI can provide detailed analytics and automatically generate reports, which can help staff detect malicious activities after the fact.

When security compliance tasks are automated for insurance carriers by machines, human compliance and security teams are freed to address complex or unique needs to safeguard their companies and their customers. AIOps and Amelia can help make all insurance processes more efficient and help them remain in compliance within a rapidly changing business environment.

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