How to Power the Smart Insurance Model with Language Intelligence

On December 10th, 2020, Sorcero CCO Richard Graves delivered a talk to the InsurTech NY event “Emerging Technologies: AI, RPA, and IoT.” You can watch in the video embedded below. The following is a lightly edited transcription of his remarks.

Every day millions of people face one of life’s most critical moments: a cancer diagnosis, the birth of a child, or a career ending injury. In those moments, they turn to their health care provider (HCP) and insurers to overcome life’s setbacks - to know that it will be ok, and to be able to afford life-changing and life-saving treatments and financial security. In that same moment, insurers start to make a specific decision that will change the life of the policyholder. 

This decision is an immense responsibility for insurers. To make such a life changing determination, insurers need to understand the context of that decision. The art and science behind insurance is understanding that all risk is contextual. To put the entire world into context, insurers as a whole must understand every sphere of human activity and how it actually operates in the real world. This is a priority and an obligation in order to make decisions that affect millions of lives every day.

For life and health insurers in particular, they face a massive, differentiated task. Medical knowledge that impacts the lives of policyholders is growing exponentially, and keeping up-to-date on it is an area where many insurance companies are struggling. The sum total of human medical knowledge doubled every 73 days in 2020. This knowledge is what insurers have sought for hundreds of years: to finally understand and analyze medical risks and the health and wellness of patients with incredible detail. To maximize the opportunity from this volume of data, insurers are turning to AI. But AI alone can’t solve this issue. 

Medical information is siloed into specialized language by its domain, the area of expertise required to understand it. The specialized language of a HCP or that of the underwriter is fundamentally different from everyday language. Medical guidelines, clinical information, diagnostic data, insurance claims: all must be processed and used to apply and deliver the context that only specialized language can. To use and apply that medical information, insurers need something other than AI. They need to infuse AI with deep domain expertise and medical understanding. 

This is what we have built: Language Intelligence. 

Together with Language Intelligence, insurance enterprises can now integrate biomedical and technical domain understanding into their core operating model and platforms. As Sorcero works with insurers, we are finding again and again that these core capabilities of Language Intelligence can transform the functions within those insurers and provide new capabilities to previously intractable problems within underwriting, claims adjustment, risk modeling, and more. Specific knowledge and expertise can bring the context from biomedical information into the core operating model of insurance.

Language Intelligence is an emerging category of enterprise software. Just as insurers are migrating to cloud infrastructure, with Language Intelligence, core systems are able to provide much more sophisticated capabilities for customer interactions and contact, employee workflows, IT, and more. New intelligence facilitates each point solution and across the entire enterprise as well. In the marketing, sales, distribution, underwriting, claims, product, and policy functions of insurers, medical understanding can provide new capabilities. 

With our current customers, we’ve used Language Intelligence to transform how they interact with their benefit and coverage information; how claims are analyzed and understood; how underwriting is undertaken; and how that content is dealt with—moving from flat databases into the seamless language understanding of a knowledge fabric. This knowledge fabric represents and evolves as a representation of the relationships between all the specialized information applied by the human experts who comprise the core functions of insurance: the underwriters, the claims investigators, the adjusters, and more.

Sorcero provides the intelligence layer and then integrates it into core decisions. By ingesting medical guidelines through Language Intelligence, for example, an insurer can understand what is the state of the art in medicine, the standard of care itself. In this way, it can be known if the treatment a policyholder received was cost-appropriate and best for health outcomes. 

Another example: A crisis requires specialized knowledge of what is emerging from medical literature, not just what is in the news. Utility sets can apply knowledge from this literature across the enterprise insurance model. Through Language Intelligence, rapidly emerging medical situations within a crisis such as COVID-19 pandemic can be tracked through medical literature on vaccines. The latest peer-reviewed publications can be broken down by mechanism of action, demographics, economics, and the institutions developing each candidate and distributing each vaccine.

As the payers for everything from vaccines to hospitalizations, insurers often transform life’s most critical moments. Language Intelligence can also provide a pre-check: knowing if the care a policyholder is receiving is on the pathway that medical science says is appropriate. Instead of requiring a prior authorization, you can actually know precisely where a policyholder is in that pathway. Language Intelligence provides clinical pathways for HCPs so that the right care is delivered at the right time with fewer errors and lower costs. 

These are not the only ways biomedical knowledge can inform the larger insurance operating model. Diagnostics comprise only 2% of the cost of healthcare, yet 66% of healthcare decisions depend on those diagnostics. Linking those diagnostics to pathways and specific medical knowledge can provide a level of understanding for insurers that can impact case management, claims and more. Language Intelligence, by ingesting diagnostic information, can provide a guidance engine across the operating model. As an insurer, you know exactly where you are because of real world data.

Such ingestion of diagnostic information can enable intelligent medical claims adjudication, so that you can streamline claims, identify whether treatments are appropriate, and flag medical overbilling in real-time. When someone has a cancer diagnosis, that policyholder can have a treatment approved faster at a moment when time matters the most, improving the prognosis and potentially reducing the total cost. 

This diagnostic information doesn’t just matter for health insurance. It matters to disability insurance, and to the waivers required in life insurance, as well as in the risk being assessed. Language Intelligence can leverage this information in intelligent life insurance underwriting. Ordinarily, there are two options for the underwriting process: potentially cumbersome and difficult to deliver traditionally underwritten life insurance underwriting; and accelerated underwriting with alternative data for low risk pools. Language Intelligence and diagnostic information provide a third way: the acceleration of traditional medical underwriting. By seamlessly integrating unstructured medical notes, electronic health records, and diagnostics, Language Intelligence can accelerate traditional medical underwriting and provide the same speed that you would get with alternate data pools. More insights can also be provided, to personalize individual policies to individual medical risks, eventually optimizing underwriting to a place where there is a policy of one.

These are just some of the capabilities we are finding from Language Intelligence. Sorcero is early in our journey. Language Intelligence is an emergent category of software. Sixty to seventy percent of the workflows in insurance are centered around language, whether driven by a conversation with a customer, by documents, by expertise, or by an underwriter or a clinical professional assessing medical risk or the appropriateness of a liability or claim. As we apply it across the insurance operating model, we’re finding new applications every day.

Ultimately, policyholders know that they can trust an insurer who can understand what is appropriate for them. Sorcero has created a way to apply that specific knowledge to build context across the entire insurance operating model. Life and health insurers have been struggling to keep up rather than leveraging the enormous, burdensome asset that is specialized language. By knowing the context and life of policyholders through Language Intelligence, we can change those lives for the better.

Contact Sorcero to learn more about what Language Intelligence can do to empower experts at your enterprise.