amaise is revolutionizing medical insurance claims management with Microsoft Azure

AI-driven efficiency: How the amaise platform works

Medical insurance claims often include a broad spectrum of unstructured documents, which is precisely where the GenAI solution from amaise comes into play. This solution uses cutting-edge AI technologies such as Azure OpenAI Service to analyze unstructured information, classify it, and transform it into a clear form that can be readily processed.

“Our AI models are specially trained to recognize and automatically categorize different types of documents such as doctor’s reports, laboratory findings, and administrative records. And all this is done irrespective of the language,” Kohli explains. “The next step is for the platform to extract all relevant information and use it to produce a structured overview—what is referred to as the ‘case DNA.’” This DNA serves as the basis for amaise’s Agentic Large Language Model Framework, which accesses the case DNA to answer specific questions from the experts.

Automation hugely accelerates such complex data processing but takes only a fraction of the time compared to manual processing. Compliance with all current valid security and data protection standards is naturally guaranteed by cutting-edge encryption methods and bring-your-own key concepts. In addition, the models trained by amaise make life easier for case processing staff by quickly summarizing reports or documents and explaining specific medical terms.

The latest feedback from customers shows that, with amaise, insurance companies can process cases up to 80% faster, with as much as four times greater accuracy and payout outcomes optimized by as much as 11%.

Microsoft: A strong and reliable partner for technology, expertise, and security

Taking part in the Microsoft for Startups Founders Hub program was a crucial success factor for amaise. Thanks to free Azure credits and early access to innovative technologies such as Azure OpenAI Service, the developers were able to work on the highest technological level: “Rapid progress in large language models in particular raised our product to a new technological level,” the CEO affirms. “Thanks to our partnership with Microsoft, we have constantly been—and still remain—on the leading edge of technological development.”

That said, the program was about much more than merely providing technology. amaise also benefits from intensive and productive dialogue with the relevant Microsoft team in Switzerland. Extensive knowledge transfer proved to be especially valuable, as the experts at Microsoft contributed their depth of technological knowledge and strategic insights into market dynamics. All this significantly accelerated further development of the platform and market access. Additionally, access to an international network of experts and potential customers opened up new opportunities for scaling: “Right from the outset, Microsoft walked with us through every step and passed on contacts that played an essential part in our success,” Kohli notes.

The company’s cooperation with Microsoft also turned out to be groundbreaking in relation to the security and data protection standards that are required in the healthcare and insurance sectors. Microsoft Azure guarantees seamless, end-to-end data encryption on the client’s side, but also during transmission and temporary storage in the cloud. Local data centers ensure that data remains within the relevant national borders. Also, the Azure Key Vault’s bring-your-own-key principle ensures that customers retain full control over data encryption. “We work with the most sensitive data in the world,” Kohli stresses, “so for us, the strictest standards of security are non-negotiable.”

More efficiency, less paper: amaise and Baloise join forces to shape the digital future

Collaboration with Baloise, one of Switzerland’s biggest insurers, illustrates how amaise is revolutionizing complex processes. The insurance company teamed up with amaise back in 2020 to launch a pilot project in its Personal Insurance Legal Services department. This initiative was prompted by a new legal provision requiring that the files to be disclosed had to feature a detailed directory and be ordered systematically and chronologically. Doing all that by hand would have taken a vast amount of time, so amaise developed a tailor-made solution that automated the dispatch of files and the structuring of documents.

After a successful pilot phase, other departments—including Accident Insurance—were also given access to amaise. In ongoing cases, the software automatically files any new documents in the right order. But it also simplifies the task of reading out and editing case-related data, extracting medical diagnoses, and summarizing documents. “amaise helps us find relevant information more quickly and structure mountains of complex files more efficiently,” says Philipp Jeker, Head of Legal & Training at Baloise. “Especially in cases spanning several hundred or even a thousand pages, that makes life so much easier.”

Change management is one factor that proved critical to successful implementation. Finely tuned training courses and the introduction of “superusers” as direct points of contact underpinned the success of the software launch. “Change management is not just about adapting your processes,” explains Michèle Eichenberger, Innovation Manager in Baloise’s Processes & Innovations department. “It is also about empowering your people to understand the potential of new technologies and make effective use of them.”

Looking ahead, Baloise already has plans to deploy amaise in further departments and to standardize its processes. The amaise software is currently being localized into French, and an Italian version is due to be launched next year. “Paperless case processing is our vision,“ Jeker says. “Together with amaise, we are creating more efficient ways of working. And that benefits both our staff and the people we insure.”

New markets, new technologies: amaise’s strategy for the future

In close consultation with its customers—and with the support of Microsoft, its partner—the amaise team is committed to continually developing and improving its platform. The aim is for new and adapted AI models to analyze complex cases even more accurately and deliver specific improvements in decision-making. Beyond this, Generative AI could in the future provide automated recommendations on the basis of comparable cases in the past. That would further increase efficiency and enhance quality. Concrete plans already exist for one innovative feature: podcast-like case analysis that would let the insurance company’s staff listen to cases even when they are on the move. This approach is designed to make staff more flexible and productive in their routine work.

At the same time, amaise is setting its sights on new markets and wants to gradually establish its solution as the global standard for the processing of medical insurance claims. Microsoft’s commercial marketplace will again play a key role as the company scales up its international activities. “Our objective is to help organizations around the world manage medical claims more intelligently and more efficiently,” Kohli explains. “That will be good for our staff, obviously, but the main benefit will be for the people who are insured, as more accurate decisions and better support will help them return to normal life more quickly.” Kohli also sees tremendous potential to spread the technology to other industries. “The principle of analyzing unstructured medical data so that it can be put to good use is not restricted to insurance alone,” the CEO insists. “Sectors such as healthcare in general could benefit just as much. For the future of amaise, it seems that the sky is the limit!"