EvolutionIQ gets $21 million to streamline insurance claims processing with AI – TechCrunch

Large-scale claims processing presents a challenge for insurers, especially when claims involve factors such as complex underlying health conditions. According to data from the National Association of Insurance Commissioners, the second most common complaint made by insurance customers in 2021 was claims delays, ranked second after unsatisfactory settlement offers.

The pandemic has put additional pressure on insurers, with an RGA survey finding that acceptance rates for permanent disability, critical illness and long-term care claims have been minimal over the past two years. Even with reduced claims requirements, the average end-to-end time for claims fell from 34 days before the pandemic to 43 days.

A growing cohort of startups, including Alan, Tractable and Snapsheet, are offering tools to help customers navigate the insurance claims process. But former Google AI technology chief Tomas Vykruta is taking a different approach with EvolutionIQ, which works with insurers to analyze claimant data and third-party information to identify “high opportunity” claims – in especially those involving bodily harm.

EvolutionIQ announced today that it has raised $21 million in a Series A round led by Brewer Lane Ventures with participation from FirstRound Capital, FirstMark Capital, Foundation Capital, Altai Ventures, Asymmetric Ventures and insurance companies Reliance Standard Life, New York Life Ventures, Guardian Life and Sedgwick. This brings the company’s total capital raised to $26.1m at a “north” valuation of $150m, following small seed and venture rounds in 2019 and 2020.

“EvolutionIQ helps insurance professionals improve claims processing through insights discovered by analyzing historical claims data,” Vykruta told VentureBeat via email. “With our business intelligence platform, claims management teams can catch up on lost time and streamline processes. Our software enables front-line operators to make more informed decisions and focus their energy on high-potential claims. For managers, we are able to identify blocks of complaints that need further investigation and those that are easily resolved, then provide guidance on how to get there.

Accelerate insurance claims

Vykruta has a long and fascinating career in the tech industry. He is the founder of two video game studios, Antartica and Electrolab, and was one of the main console software architects at Surreal Software, a subsidiary of Warner Bros. Interactive Entertainment. In 2008, V.ykruta took a job at Microsoft as a senior engineer in the advanced technology group, where he worked on software for the Xbox 360. And in 2016, he joined Waymo, the company’s self-driving car division. Google’s mother, Alphabet, as a machine learning engineer.

Vykruta spent the last decade of his career on various machine learning teams at Google before co-founding EvolutionIQ with Jonathan Lewin and Michael Saltzman, one of the founders of campus furniture rental company Roomie.

“While adopting AI in a traditional industry can be challenging, [it can be] overcome by building ‘explainable AI’ systems in close collaboration with users,” Vykruta said. “The [must be] two systems: one that makes predictions [and] the one that explains the expected results in [plain] Tongue.”

With EvolutionIQ, Vykruta, Lewin and Saltzman set out to design a platform that assesses the history of claims – particularly health-related claims – up to the present to answer questions such as “Is it a claim we can act on?” and “Will there be a result that makes sense?” Using EvolutionIQ, Vykruta says an adjuster, who may have hundreds of active cases at a time, can better understand claims for short-term disability, long-term disability, workers’ compensation and property and accident compensation; identify the most exploitable opportunities; and see results in the context of new data and events.

“[C]The claims are really incredibly complicated because you have these accounts that have been open for many years. Some of these claims are 15 or 20 years old. They have up to 30 to 40 medical diagnoses. The insurance industry cannot solve this problem comprehensively,” Vykruta explained. “What this has led to is an incredible waste of unnecessary payments. Reviewers [may] look at the last two pages of notes and usually they take no action at all.


The claims view in EvolutionIQ.

Informed by its predictive algorithms, EvolutionIQ shines a light on dozens of claims out of tens of thousands that are most likely to have the best outcome for claimants, carriers and customers. EvolutionIQ also monitors open grievances to guide workers to those that need more attention or further action, including grievances that have potentially slipped through the cracks.

“Claims examiners want to focus on the cases that have the biggest impact on customers and carriers. But handling claims involves archaic, manual processes that require reviewers to review too much information or assess data on their own, despite the fact that each claim involves multiple people and systems,” Vykruta said. “Therefore, we built a business intelligence platform that acts as an AI-enabled co-pilot to identify high-opportunity claims early in the lifecycle and the cases most likely to be referred to experts. in claims.”

Market opportunity

According to Vykruta, EvolutionIQ’s value proposition reduces overpayments, waste and longer claim times. Insurance company teams are stretched by rising claims volumes and the systems tasked with making management scalable are actually compounding the problem, he claims, forcing reviewers to make trade-offs that lead to decisions slower and more error-prone.

“Claims can last for years, many are worth six figures, and involve hundreds of pages and many formats (both structured and unstructured) that are constantly pouring in…In fact, we are giving claims organizations time back by identifying cases that don’t need to be dealt with and can be tuned to be resolved,” Vykruta said.[We’re working with] top disability, property and casualty insurers and third-party administrators, including Reliance Standard, Principal, Sun Life, Argo Group, Matrix Absence Management and FullscopeRMS.

Of course, AI has a well-known bias problem, and reports over the years have revealed how supposedly “fair” algorithms in insurance can perpetuate different forms of discrimination. Algorithms have led insurance companies to charge higher premiums to minority communities than to white communities, for example, even when the risks are the same. Asked how EvolutionIQ mitigates the potential for this type of bias, Vykruta says the company invests in “explainability” approaches that clarify the type of factors that drive platform decisions.

“EvolutionIQ don’t just take the raw weight of the model. They translate the system that makes sense [claims adjusters]“, Vykruta said.”[The platform is] only showing them [items] which are usable.

Risks aside, EvolutionIQ is not alone in seizing this opportunity. Among its rivals is CCC Intelligent Solutions, a technology solutions provider for the auto and insurance industries that uses data science to speed up claims processing. Riskcovry is another startup in the fledgling space, with clients including banks, fintechs and supply chain brands.

The EvolutionIQ Team

The EvolutionIQ team.

But the insurtech market is teeming with cash, with one report estimating global investment in insurance tech startups in 2021 topped $10 billion, up from $3.1 billion in 2020.

Vykruta says EvolutionIQ – which was cash flow positive in 2021 – will devote most of the new capital to expanding its engineering, data science, product and customer success teams. Customer acquisition will also be a priority going forward, he says, as EvolutionIQ explores new and emerging insurance categories.

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