AI & Data: Automated Claims Processing
Reducing claim settlement time from days to minutes using intelligent document processing.
The Challenge
S.C's agents spent hours manually typing data from PDF receipts and photos. Fraud detection was manual and inconsistent. They needed an automated system to extract data, validate policy limits, and flag fraud.
The Solution
GTEMAS delivered an Intelligent Document Processing (IDP) solution. OCR: Extracts text from images. NLP: Classifies items (e.g., 'Antibiotics' vs 'Vitamin'). Rules Engine: Checks policy limits. Decision: Automatically approves simple claims <$500.
Architectural Strategy
Serverless pipeline. Upload -> S3 -> Lambda (OCR) -> Rules Engine -> Payment Gateway.
Impact & Achievements
Customer satisfaction scores (NPS) soared. The system scaled effortlessly during a dengue outbreak surge.
Claims processed without human
Down from 3 days
Processing cost per claim
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