Reliance Matrix’s Chief Claims Officer on AI: Like Lighting in a Bottle

As EvolutionIQ’s first client, top disability carrier Reliance Matrix has the longest track record in the industry using AI-powered claims guidance. Scott Boutin, Senior Vice President/Chief Claims Officer, Reliance Matrix, and President, Standard Security Life Insurance Company of NY, recently stopped by EvolutionIQ’s New York City headquarters for a fireside chat with employees. The freewheeling discussion centered on the immensely positive impact the platform continues to have on their business, their claims examiners, and most importantly, sick or injured claimants.

We started the journey with EvolutionIQ with the question, How can we use data to drive claims management, which has really never been done before in our industry, he told his EvolutionIQ partners in the room and also attending via Zoom. It’s always been hunting and pecking for claims. You are looking at every single claim, one at a time, trying to find an opportunity [to make an impact]. Now, [claims guidance] has really changed the way we work. It is like lightning in a bottle.

In Short Term Disability, Scott’s team is using EvolutionIQ’s triage software to accurately divide claims into three segments: simple claim decisions that can go on a faster track, complex claims that require more examiner involvement, and those with a high likelihood of transitioning to Long Term Disability, which requires a different set of examiner specialists. In that Long-Term claims block, the platform is reducing time spent on claims that are already on a smooth path and instead guiding examiner attention to those sick or injured claimants who could most benefit from attention.

Claims is always a people-focused business because you need people to service the customer and to have conversations around medical so the need for people doesn’t go away, he continued. But [claims guidance] makes it a lot easier for examiners to focus less on digging into the claim and searching for stuff the administrative process versus, I can have the answers now and go have a conversation and service the customer.And that is really what it’s evolved to now with the process you all have helped us build and continue to refine as we find new ways to look at claims. So it’s been pretty exciting to see Reliance Matrix grow over the last couple of years using this and all of the work that you guys do. It’s been pretty amazing to see us go from where we were to where we are.

Disability is not for the faint of heart because it is tough people are at their worst moment in their life in some cases. It is great to have someone focus on that versus trying to find a claim, going through it note after note You would lose time and [as a result] could not spend all that time needed servicing the people. We are a service business. Claims is service. Insurance is service. There is no tangible product. So that is what we differentiate on. When we go out to sell, we sell our people and being able to say they are efficient, that they are only focused on servicing and not all of the other stuff. We’re giving [our examiners] the information they need that can help people.

While the AI helps to reduce claim durations, Scott underscored that Disability isn’t about closing claims. The work we do together when we recertify a claim, it’s just as important as when we close it. We want to help people. We want to service people. We want to pay the right people the right claim for the right amount at the right time. It is not about closing claims It’s getting to a steady-state. Having consistency.

That consistency also has a positive financial impact for insurers. Scott noted that Reliance Matrix’s financials have dramatically improved as a result of using AI-powered claims guidance, sending them into the top quartile vs peer companies. For example, Reliance Matrix has been able to reduce reserves by 8-figures, directly attributable to the AI platform, as described in our recent case study.

We’re best in class now from a financial standpoint, loss-ratio standpoint we can compete with anybody from a comparative standpoint, he told the audience. And we’re winning a lot more business now, too. It has really helped us reposition how we manage claims

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