Overview

The constantly evolving regulatory and compliance framework within the insurance industry calls for more stringent governance and stricter adherence to mitigate risk of customer complaints or penalties from potential breaches. Additionally, evolving customer expectations have been driving insurers to enhance capability by exploiting cutting-edge technologies and by monitoring trends for swift remedial action for a superior customer experience. Lastly, growth-driven insurers are also increasingly seeking optimal cost efficiencies through reduced complaints, and mitigated financial pilferages, which could be in the form of leakages, penalties and fines for compliance and regulatory breaches.

Therefore, it is imperative to increase internal controls and governance in order to reduce risk, and pro-actively identify and resolve potential issues. Undeniably, accurate and timely audits are critical to ensure adherence by insurers to the general insurance code of practice and to reduce claims leakage with a strong focus on crucial business & customer outcomes. However, traditional audit processes are highly manual and dreary, and call for

Intelligent digitization of the audit function—does value yielded prevail over outlay?

The pertinent challenges, as established, necessitate a cutting-edge digitized audit solution aiming to create exceptional value for clients through the following intrinsic features:

  • Increased audit coverage by 60% - 70%, with marginal increase in operational cost
  • Optimal exploitation of analytics and technology for seamless automation of the quality audit process
  • Prime focus on manual quality assurance on high risk and/or complex scenarios
  • Automated and real time dashboard offering actionable insights
  • Standardized approach across all LOBs

EXL Smart Audit solution—an integrated solution combining domain expertise and advanced digital technologies to deliver enhanced customer experience and desired business outcomes

EXL Smart Audit solution is an integrated solution combining data analytics, advanced technologies like artificial intelligence and machine learning (machine learning), as well as technology and process expertise. Sophisticated AI-based natural language processing (NLP) modules enable Smart Audit to extend audit coverage beyond rule-based scenarios to intelligently generate triggers for manual scrutiny of high risk or complex scenarios. Focusing on enhancing customer experience and delivering distinctly established business outcomes, the quality assurance solution enables agile decision-making through relevant customer data points and actionable insights. It is predictive in nature, and robust enough to highlight pertinent gaps within the process.

Delineated below are the salient features of EXL Smart Audit solution:

smart audit

What differentiates EXL Smart Audit solution?

Data and technology driven approach to audits with significant potential to reduce leakage and risk exposure

Smart Audit

Key solution modules

Here is a quick lowdown on the key modules comprising EXL Smart Audit Solution:

Data aggregation: aggregates various sources of data and information required to perform the audit

Q&A model & decision: layer uses auditor help to identify key words or phrases, on the notes or e-mails, to answer associated questions in audit forms

Data extraction: content and intent extraction from various structured, semi-structured and unstructured documents such as emails, documents, agent notes, etc., And feeding them for model processing

Digital quality assurance: documents each step of the manual audit process and aggregate model output and info in each step to generate an audit outcome. Generates insights, recommendations and preventative triggers for operations to act.

EXL Smart Audit solution builds upon existing data flows and technology infrastructure to deliver tangible business impact

EXL has engaged successfully with large Australian insurers for deployment of Smart Audit solution and shown effectiveness improvement through the solution

Unrivaled value realization for clients

The solution benefits the insurance industry across geographies by targeting higher risk interactions and identifying possible leakage through analytics. Current solution architecture ensures comprehensiveness of the solution, minimizes cost to build, maintain and improve, and leverages the right solution for various inputs to arrive at the desired outcome of QA intent

Smart Audit

Expressly, clients benefit in the following ways:

  • Prevention of regulatory breaches, early identification of complaints, potential leakages –leading to considerable reduction in penalties, complaints, and leakages
  • QA review across consumer and commercial lodgement and fulfilment, recoveries, and settlements
  • Analytically-driven, low-touch automated audits, leading to objective assessment
  • Fewer violations leading to superior customer satisfaction
  • Enhanced claims management experience due to end-to-end evaluation of customer journeys, as against individual touchpoints
  • Manual QA review better targeted to higher risk interactions and/or more complex obligations

Business benefits

70-80%

coverage of audit across claims interactions

40-50%

Reduction in financial leakage

5-10%

Reduction in complaints handling fee to regulator

>90%

Confidence level in reporting compliance adherence

50-60%

of the solution repeatable across other clients in same geography

20-30%

Reduction in legal reserves

3-5%

Reduction in loss management