Accelerating Claims Intelligence with Infoslab's AI Talent Solution in Insurance

Project Overview

A mid-sized North American health insurance provider, serving over 3.5 million policyholders, struggled with delayed claims settlement, rising operational overheads, and increasing customer dissatisfaction. Their vision was to enable real-time claims intelligence — using AI to classify, prioritize, and settle claims with minimal human involvement — but internal hiring constraints and siloed legacy systems stalled progress.

Industry

Insurance

Challenge

The client's claim processing lifecycle was outdated and heavily manual. Most of their data lived across structured policy tables and unstructured medical documents, scanned reports, and diagnostic summaries. Specific challenges included:

• High processing delays: Average claim processing time exceeded 8 days.

• Low automation rate: Only 11% of claims were handled without manual intervention.

• Fragmented systems: No unified intelligence layer existed across claim intake, validation, and adjudication.

• Hiring roadblocks: Recruitment of AI engineers with insurance domain knowledge exceeded 3 months on average.

• Compliance risk: With regulations like HIPAA and GDPR, every enhancement required strong governance and explainability.

Infoslab’s Talent-Led Solution

Infoslab rapidly deployed an AI-focused cross-functional delivery team with 15+ experts in under 10 business days, integrating seamlessly into the client’s operations. The engagement was led and executed through our Tech Talent Solution Model, allowing maximum velocity, reduced hiring dependency, and embedded domain context

Team Composition:

• NLP Engineers: Developed AI models to extract and structure diagnosis codes, treatment plans, and policy clauses from unstructured documents using transformer-based models like ClinicalBERT.

• Claims Data Scientists: Designed intelligent classification pipelines to predict claim complexity, potential fraud risk, and payout confidence.

• MLOps & Infra Engineers: Deployed model pipelines using AWS SageMaker, integrated with existing claim systems via API Gateway and Lambda.

• Data Engineers: Migrated ETL workloads from on-premise systems to AWS Glue and Redshift, enabling scalable and maintainable data pipelines.

• Compliance & Governance Experts: Set up automated de-identification workflows and audit trails aligned with HIPAA, GDPR, and internal controls.

• Agile Delivery Coordinators: Ensured weekly value delivery, stakeholder demos, and consistent backlog grooming in partnership with business teams.

Why Infoslab?

• Top-Tier Data Engineering Talent: 12+ experts deployed in <2 weeks with AWS, Glue, PySpark, Terraform, and DevOps fluency.

• Cost-Efficient Modernization: Migrated entire ETL infrastructure without disruption — cutting costs by 62%.

• End-to-End Ownership: From architecture to delivery and knowledge transfer, Infoslab owned the full modernization lifecycle.

• Future-Ready Platform: Enabled downstream AI, real-time analytics, and scalable data product delivery.

Get in Touch with Infoslab

AI and Engineering Highlights:

• Built and deployed an end-to-end AI-powered claim intelligence engine that processed incoming claims, extracted key variables from attachments, and assigned complexity scores.

• Created a document embedding service using Sentence Transformers and vector search, improving case-matching speed by 4×.

• Integrated the AI engine into the core claim adjudication workflow via serverless AWS infrastructure.

• Enabled real-time analytics dashboards for operations and compliance teams using Amazon QuickSight and Redshift Spectrum.

Key Business Outcomes

• Reduced average claim processing time from 8.2 days to 3.1 days — a 62% improvement.

• Increased touchless claims processing rate from 11% to 38% — more than 3× automation gain.

• Lowered manual review volume by 57%, freeing up internal staff for complex cases.

• Achieved $2.1 million in annual operational cost savings through automation and reduced rework.

• Accelerated solution delivery — from a projected 90–120 days internally to just 28 days with Infoslab.

• Delivered 100% compliance audit coverage, meeting HIPAA, GDPR, and SOC2 standards.

• Enabled internal team uplift, with 12 client-side staff trained to maintain and extend AI solutions.

• Reduced need for internal AI hiring cycles by over 75%, ensuring faster go-to-market.