Backbone of Insurance Companies

WeCanAllPullTogether

Some of my mates work in the IT department of insurance companies. I asked them if there's a computer system to determine if claims should be paid, rules based logic or AI system, that kind of thing. But apparently this part of the claims process system is a mystery, full of the Dark Arts.

The lads say they write a 3 Tier CRUD system, database to fronted, etc. It doesn't do any fancy mathematics, other than summing up table columns.

So the question is " how do insurance companies determine if claims should be paid or not" ?

Somebody told me they outsource this work to the Shady Underground, and network of drones and old ladys behind netted curtains, the wierd planted guy who sits next to you in work, but doesn't seem to do anything.

So it's like insurance companies hook into some sort of secret framework?

Quote from movie Flight : "The insurance companies can have the God Dammed Eir Lyin IT", "I never wanted IT, it was my Daddy".

Potential-Monke

I'd imagine they all have a team of highly paid solicitors going through each and every claim to find the loophole to get out of paying. They undervalue the damage (but overvalue when quoting most likely) and I think use something like the Book of Quantum to asses personal damages.

WeCanAllPullTogether

Have you worked inside an Insurance Company? They are not as structured as you think, if you come from tech startups or scientific background.

I would say they are very influenced by rich and powerful, who want to go in a certain direction on ths (Square Peg, Round Hole, etc).

banie01

IBM's Watson and similar machine learning are becoming embedded across the industry.

Massively reduces workload and headcount though. Humans are the sanity check factor now rather than the actual arbiter.

I have experience in this field from prior career in finance and Telco regulatory field.

https://www.ibm.com/watson/stories/insurance#:~:text=Watson%20works%20behind%20the%20scenes,hours%20of%20time%20each%20month.

https://www.lpa.com/blog/how-ibm-watsons-predictive-analytics-is-changing-the-insurance-industry

WeCanAllPullTogether

A solicitor doesn't know if you are telling the truth about the claim, for that more of a grey Swirls and Twirls across a mesh approach is required, a bit like a Church.

(or the fundamental mesh framework all Churches are built upon)

Ten of Swords

Thread closed

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