Artificial Intelligence at Work—How AI is Elevating Employee Benefits Insurance

Whether we notice or not, AI is becoming a part of our everyday lives. Integrated strategic applications of AI are a natural next step in the world of Employee Benefits. From underwriting and risk evaluation, claims management, customer service and personalization, as well as fraud detection—AI is transforming how insurers do business and ushering in a new wave of innovation.

According to Ethical AI in Insurance Consortium (EAIC) 80% of insurers are either already using AI or planning to do so within the next year. While the potential of generative AI in employee benefits is vast, successful implementation requires careful consideration around data privacy, ethics, transparency, and integration. But, when instituted carefully, it can not only improve efficiency, but it can also help improve service levels and satisfaction for customers.

As THE Premier Multinational Pooling Network, Insurope understands its Network Members are increasingly turning to Generative AI, with 88% of those who responded to a recent survey reporting they have already been using it. Most report rationale for implementation of AI as improved efficiency and customer service.

AI in Action

A prime example is one of the largest insurers in Brazil, Icatu, which uses a technology that automatically monitors calls through the company's relationship channels. AI captures aspects of interactions to create automatic indicators, such as mentions of dissatisfaction, multiple callbacks to customer service, feelings, and complexity of cases, from the voice of the customer, indicating situations in which irritability, satisfaction, praise, and impatience may exist.

In addition, AI optimizes Icatu’s internal processes, automating administrative and back-office tasks related to customer service, freeing up time for more strategic interactions. AI's multichannel integration across touchpoints like social, email, phone, and websites ensure a consistent experience. It also offers proactive support, identifying issues before they become critical, and continuously learns from past interactions to improve their responses and suggestions.

Across all aspects of Employee Benefits, we see insurers like Icatu leveraging AI in several common areas. These include claims, documentation, and customer support.

Claims—In claims, for example, automating the claims processing workflow with generative AI can make the process faster and more efficient, reducing the time and cost associated with manual processing. AI can automatically validate claims, check for inconsistencies, and expedite approvals, ensuring that employees receive their benefits promptly. This improved efficiency also reduces administrative burdens for insurers, allowing them to reduce costs and focus on enhancing their services.

Document Generation—Generative AI can create personalized documents such as benefit summaries, enrollment guides, and policy documents. By automating document generation, insurers can provide accurate and customized information to employees, enhancing their understanding of available benefits and simplifying the enrollment process.

Fraud Detection—By recognizing patterns in data, generative AI can help identify and prevent fraudulent claims. AI algorithms can detect anomalies and suspicious behavior, flagging potential fraud for further investigation. This proactive approach reduces the incidence of fraud, protecting insurers from financial losses and ensuring that benefits are directed to those who genuinely need them.

Customer Support—AI-powered chatbots can handle routine inquiries, provide instant responses, and free up human agents for more complex issues. These virtual assistants can offer 24/7 support, ensuring that employees receive timely assistance with their benefit-related questions. This improved customer support enhances the overall employee experience and increases satisfaction with benefit programs.

As an example, Seguros El Roble, the largest insurance company in Guatemala, which leads the market in health and life insurance is using AI for customer service. The company has developed a chatbot for client queries. This assists with more effective and efficient responses when clients inquire about their benefits, coverages, and more!

Similarly, Adisa, which is ranked as a top 3 insurer in Costa Rica leading the life and health insurance market, leverages AI to enhance the customer experience. Through AI the company is able to obtain information more quickly regarding the specific conditions of clients’ insurance policies. It also leverages AI to draft communications to policyholders about the benefits of their insurance policies.

However, there are also use cases specific to each type of benefit. For example:

Life Insurance

Underwriting—Generative AI can enhance the underwriting process for life insurance by analyzing vast amounts of data to assess risk more accurately. AI can evaluate an applicant's lifestyle, and other factors to determine the likelihood of a claim. This results in more precise risk assessment, enabling insurers to offer competitive premiums while maintaining profitability.
Policy Personalization—AI-driven insights can also help insurers design personalized life insurance policies that cater to individual needs and preferences. By considering factors such as financial goals, Generative AI can recommend tailored coverage options that provide optimal protection for policyholders and their beneficiaries.
Customer Engagement—AI-powered virtual assistants can provide policyholders with 24/7 support, answering queries about policy details, coverage options, and claims procedures. These virtual assistants can enhance customer engagement by offering personalized advice and timely assistance, improving the overall customer experience.

As an example, Mandatum, one of the most respected and well-established life insurance and wealth management companies in Finland leverages (or is piloting) generative AI for several areas of the business. The current use cases include quickly and easily finding materials and instructions, summarizing and analyzing customer service interactions and feedback and producing translations. In addition, machine learning has long been used for analytical purposes.

Similarly, Nationale Nederlanden, one of the most prominent insurers in the Netherlands, is another insurer utilizing AI for analysis. It has implemented tools that enable the organization to summarize incoming client calls for themes and sentiments, enabling it to respond in real time to trends.

Healthcare

In the Healthcare and Medical insurance realm, GNP, the oldest and largest insurer in Mexico, is looking to AI for underwriting of individual plans, as well as prevention, and detection of fraud. These applications are furthering their competitive advantage, as well as their commitment to innovation. Below are some other common applications of AI that we are seeing in this sector.

Personalized Health Plans—Generative AI can analyze vast amounts of patient data to create customized healthcare plans tailored to individual needs and medical histories. By considering factors such as lifestyle choices, AI can design health plans that optimize preventive care and treatment outcomes. This personalized approach not only improves patient satisfaction but also reduces overall healthcare costs by focusing on early intervention and tailored care.
Predictive Analytics—One of the most significant advantages of generative AI in healthcare is its predictive capabilities. By analyzing historical data and identifying patterns, AI can predict potential health issues before they become critical. This allows for early intervention, better resource allocation, and ultimately, healthier employees. For instance, generative AI can forecast the likelihood of chronic conditions like diabetes or heart disease, enabling insurers to offer proactive support and preventative measures.
Virtual Health Assistants—AI-driven chatbots and virtual assistants can provide 24/7 support to employees, answering health-related questions, scheduling appointments, and offering basic medical advice. These virtual assistants can handle routine inquiries, freeing up healthcare professionals to focus on more complex cases. Additionally, they can provide consistent and accurate information, improving the overall employee experience and ensuring timely access to healthcare services.

Disability Insurance

Risk Assessment—Generative AI models excel at evaluating risk by analyzing historical data and predicting the likelihood of disability claims. By considering a wide range of factors, including occupation, health status, and lifestyle, AI can provide more accurate risk assessments. This enables insurers to price policies more effectively, manage risk better, and offer competitive premiums.
Rehabilitation Planning—Generative AI can help design personalized rehabilitation plans for individuals based on their specific conditions and needs. By analyzing patient data and rehabilitation outcomes, AI can recommend tailored rehabilitation programs that maximize recovery and improve quality of life. This personalized approach ensures that employees receive the most effective support during their recovery process.

Pension Plans

Investment Strategies—AI can analyze market data and trends to suggest optimized investment strategies for pension funds. By leveraging generative AI, insurers can create dynamic investment portfolios that adapt to changing market conditions and maximize returns. This strategic approach enhances the growth potential of pension funds, providing employees with greater financial security in retirement.
Communication—Generative AI can automatically generate reports and updates about pension plans, helping employees better understand their retirement benefits and options. AI-driven communication tools can provide clear, concise, and personalized information, improving transparency and engagement. This ensures that employees are well-informed about their pension plans and can make informed decisions about their retirement savings.
Anomaly Detection—Detecting unusual patterns in contributions or withdrawals is crucial for preventing fraudulent activities or errors in pension plans. Generative AI can continuously monitor transactions and flag anomalies, enabling insurers to take swift action. This proactive approach ensures the integrity of pension funds and protects employees' retirement savings.

Endless Applications

In fact, Icatu has also just launched A.V.I., the first AI assistant on the market with customer portfolio management. The tool was created to streamline the sales professional's day-to-day life and help leverage their production. A.V.I. can be accessed directly, simply and immediately, through WhatsApp, without having to enter websites or use a computer. Based on data analysis, the tool automates several tasks related to the management of the customer portfolio, optimizing the broker's time.

Among the features are: quote, proposal pre-filling, and custom sales arguments. Another unprecedented feature is that the virtual assistant also accepts any file format: video, image and text.

In today’s market, it would be difficult to find one that is not exploring it. For example, Baloise, Insurope’s Network Member in Switzerland, is encouraging its employees to leverage AI, while it investigates the implementation of GenAI solutions in various other parts of the business.
In the end, whether insurers are using Generative AI today or exploring it for tomorrow, offers substantial potential to transform the way insurers manage and deliver employee benefits. By leveraging AI's capabilities, insurers can provide more personalized, efficient, and proactive services in healthcare, life, disability, and pension plans. As the technology continues to evolve, its integration into employee benefits programs will undoubtedly enhance the overall employee experience and drive better outcomes for both insurers and employees. Embracing generative AI is not just an opportunity; it is a strategic imperative for insurers looking to stay ahead in a rapidly changing industry.

By Morten Unneberg
CEO, Insurope