New AI Model Helps CCMSI Seal The Cracks In The Claims Cycle

CCMSI, a large boutique third party administrator (TPA), has been providing innovative risk management solutions to thousands of companies for more than 40 years.

As artificial intelligence (AI) began emerging, CCMSI was early to adopt, and over the last several years, they developed an AI-driven intervention model that has been implemented with tremendous success.

This new model had a simple goal: Use AI to flag at-risk claims for adjusters and ensure nothing falls through the cracks throughout the claims process.

While they had been monitoring AI applications for years, CCMSI’s new model truly began in 2013 when they started studying the impact of comorbidity factors on a claim.

Through that analysis they discovered that two or more comorbidity factors could increase the claim’s complexity by as much as 10 times. This defining insight led them to think further about the other factors that might have major claim impacts.