Optimized Claims Processing – Ethias
Challenge
Processing health claims is often a frustrating and time-consuming experience for policyholders. After an accident, customers must manage and submit numerous medical documents and invoices, only to face delays in reimbursement due to manual processing inefficiencies. As Belgium’s fourth-largest direct insurer, Ethias serves over one million policyholders and processes a high volume of claims daily. To enhance efficiency and provide a smoother experience for its customers, Ethias sought a solution to accelerate and streamline claim settlements.
Nature of collaboration
To streamline the reimbursement process, Ethias integrated Skwiz, Sagacify’s AI-driven document processing solution. Within this use case, Skwiz serves as the intelligent processing layer, automatically handling the incoming stream of emails and documents to convert them into structured data for reimbursement systems.
What we built
Our partner platform Skwiz automates various document processing tasks, with its capabilities continuing to expand. Some of its features include:
- Document splitting: Automatically separates incoming files into individual documents by identifying first and last pages using visual page features, OCR text, and document characteristics such as size, handwritten content, and date patterns.
- Document classification: Determines the document type by classifying pages based on text content and assigning a class only when all pages of a document match, ensuring consistent document identification.
- Data extraction: Extracts key invoice information required by reimbursement systems, including analysis dates, patient amounts, mutuality amounts, etc. using a mix of AI models and rule-based validation.
- Validation and correction support: Provides operational interfaces that allow users to review, correct, and re-split documents when needed, including post-extraction adjustments and table validation.
- System integration: Connects with existing infrastructure through OCR services, secure file transfers, GDPR-compliant cloud environments, SSO, and mainframe systems to feed extracted data into IMS.
Impact
250k
Documents processed annually across eight different types
80%
2.5
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