Technology & Tools Flashcards

Which technology converts scanned paper medical bills into machine-readable text for automated bill review?

Answer: Optical character recognition (OCR)

OCR extracts text from images and scanned documents so it can be processed by software.

Social network (link) analysis is most useful in claims for:

Answer: Identifying connections among claimants, providers, and attorneys that suggest organized fraud

Link analysis reveals hidden relationships across many claims, a hallmark of organized fraud rings.

After a hurricane, an insurer overlays its policy locations on satellite imagery and storm-path data. This mainly helps the claims department to:

Answer: Estimate claim volume and deploy adjusters where damage is concentrated

Geospatial tools let insurers anticipate claim counts and position resources before claims are even reported.

An adjuster receives claimant photos of vehicle damage. Which data embedded in the image files could help verify when and where the photos were taken?

Answer: Metadata such as date, time, and GPS coordinates

Photo metadata (EXIF) can include timestamps and location, helping confirm or question the claimed loss details.

Robotic process automation (RPA) is best suited for which claims task?

Answer: Repetitive, rules-based tasks such as copying data between systems

RPA bots mimic simple, repetitive human keystrokes and work best on predictable, rule-driven processes.

Why must insurers monitor AI claims models for bias?

Answer: Biased models can produce unfair discrimination against protected classes and violate regulations

Regulators expect insurers to ensure algorithms do not unfairly discriminate, so models need testing and governance.

A claimant submits a video walk-through of a damaged kitchen through the insurer's app while an adjuster guides them live. This is an example of:

Answer: A virtual (remote) inspection

Virtual inspections use live video to assess damage without sending an adjuster to the site.