Softlogic Life settles first claim through AI

In a groundbreaking move, Sri Lanka’s leading health insurer, Softlogic Life, settled its first claim through Artificial Intelligence (AI), signalling a huge move towards embracing the latest technology that will power the company’s processing ability, enabling substantial improvements in operational efficiency and customer convenience. 

The AI-developed claim process involved the submission of a scanned document that was processed through several different parameters that are usually manually scrutinised and checked, and relevant verifications and authorisations obtained without any human intervention, with payment instructions relayed via CEFT for instant credit to the customer.

Softlogic Life disrupted the industry by launching the InstaClaim app. This claims management application enabled corporate employees to file, process, and claim claims within 48 hours, which is still the fastest in the industry. This eliminated extra intervention by human resources departments, especially during COVID-19 when company work models had to shift entirely to a work-from-home setting.

Building on this success and driving further value to customers through modern technology, Softlogic Life has now introduced an advanced AI and machine learning-based process, fondly referred to as ‘Lifey’, to evaluate and process claims in around two minutes. 

‘Lifey’ helps manage claim assessment, allowing expert claim scrutinisers to focus only on complex cases. This ensures that all claims are processed with maximum efficiency and accuracy. Furthermore, using AI and machine learning speeds up the claim settlement process significantly and enhances the precision and reliability of the evaluations, providing customers with a seamless and hassle-free experience to finally receive their claim value to their own bank account as a result of integrating the CEFTS (Common Electronic Fund Transfer Switch) payment facility.

The AI process meticulously verifies and processes claims submitted through the InstaClaim app. Once a claim is applied, the AI process reviews the submitted documents, such as doctor prescriptions and pharmacy bills, just like a human would. It checks for fraudulent activities and duplicates, ensuring all documents are genuine and unaltered. Furthermore, it classifies these documents and performs prescription validation, confirming the presence of a doctor’s seal. It also cross-references pharmacy bills to ensure that all medications listed were prescribed by the doctor.

The company has leveraged Microsoft Azure OpenAI, which provides confidence and trust in a reliable and secure system for efficient claim processing. Azure OpenAI delivers scalable, high-performance AI capabilities integrated with Azure’s robust infrastructure. Advanced large language models (LLMs) have been utilised to enhance decision-making and automate complex tasks precisely. 

After completing all verifications and validations, the claim is submitted to the CEFTS through robotic process automation. Subsequently, the policyholder receives the claim settlement. This advanced technology expedites the process and builds trust by ensuring accuracy, security, and transparency, reinforcing our commitment to providing reliable and efficient claim processing for our customers.

Softlogic Life Managing Director Iftikar Ahamed said: “We are delighted to move into the AI world with this small step that promises phenomenal gains in the future. At Softlogic Life, we have always believed in being ahead of the curve, and we feel that AI is likely to bring about massive changes in how we do business. By revolutionising the way claims are processed, we are not just enhancing our service to the 1.3 million lives we protect, but we are also opening up opportunities towards a future where advanced technology transforms every aspect of life insurance from purchasing a policy, underwriting, servicing, and claims. This significant milestone reaffirms our dedication to being at the forefront of industry advancements and delivering unparalleled value to our policyholders through technology.”