EvolutionIQ secures $21M to streamline insurance claims processing with AI – Yahoo News

Processing claims at scale presents a challenge for insurers, particularly where the claims entail factors like complex underlying health conditions. According to data from the National Association of Insurance Commissioners, the second-most common complaint that insurance customers made in 2021 was claim delays, ranked only after unsatisfactory settlement offers.

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

A growing cohort of startups, including Alan, Tractable and Snapsheet, offers tools to help customers navigate the insurance claims process. But former Google AI tech leader Tomas Vykruta is taking a different tack with EvolutionIQ, which works with insurers to analyze claimant data and third-party information to identify “high-opportunity” claims — specifically those involving bodily injury.

EvolutionIQ today announced that it 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 carriers Reliance Standard Life, New York Life Ventures, Guardian Life and Sedgwick. It brings the company’s total capital raised to $26.1 million at a “north of” $150 million valuation, following small seed and venture rounds in 2019 and 2020.

“EvolutionIQ assists insurance professionals in improving claims handling through insights uncovered by analyzing historical claims data,” Vykruta told TechCrunch via email. “With our decision intelligence platform, claims teams can recoup lost time and streamline processes. Our software allows front line operators to make more informed decisions and focus their energy on high-potential claims. For managers, we’re able to identify claims blocks that need further investigation and those that are easily resolved — and then provide guidance to make it happen.”

Story continues

Accelerating insurance claims

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

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

“While adoption of AI in a traditional industry can be challenging, [it can be] overcome by building ‘explainable AI’ systems in tight collaboration with the users,” Vykruta said. “There [must be] two systems: one that makes predictions [and] one that explains the forecasted outcomes in [plain] language.”

With EvolutionIQ, Vykruta, Lewin and Saltzman set out to design a platform that evaluates the history of claims — specifically health-related claims — up until today to answer questions like “Is this a claim on which we can take action?” and “Is there going to be an outcome that makes sense?” Using EvolutionIQ, Vykruta claims that a claims adjuster, who may have hundreds of cases active at a time, can better understand short-term disability, long-term disability, workers comp and property and casualty claims; identify the most actionable opportunities; and see the results in the context of new data and events.

“[C]laims are really incredibly complicated because you’ve got these narratives that are open for many years. Some of these claims are 15 or 20 years old. They have as many as 30 to 40 medical diagnoses. The insurance industry can’t solve this comprehensively,” Vykruta explained. “What this has led to is just incredible waste in unnecessary payments. Examiners [may] look at the last couple of pages of notes and generally, they don’t take any action at all.”

EvolutionIQ

The claim view in EvolutionIQ. Image Credits: EvolutionIQ

Informed by its predictive algorithms, EvolutionIQ spotlights dozens of claims from tens of thousands that are most likely to have the greatest outcome for claimants, carriers and clients. EvolutionIQ also monitors open claims to guide workers to those that require more attention or new actions, including claims that have potentially fallen through the cracks.

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

Market opportunity

The way Vykruta sees it, EvolutionIQ’s value proposition is reducing overpayment, waste and longer claim durations. Insurance carriers’ teams are stretched thin by rising claim volumes, and the systems responsible for making management scaleable actually compound the problem, he asserts — forcing examiners to make tradeoffs that lead to slower decisions and mistakes.

“Claims can last years, many worth six figures, and involve hundreds of pages and many formats (structured and unstructured) constantly flowing in … We actually give time back to claims organizations by identifying the cases that don’t need to be addressed and can be set to be resolved,” Vykruta said. “[We’re working with] the top disability carriers, property-casualty carriers 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 reporting throughout the years has exposed how supposedly “fair” algorithms in insurance can perpetuate different forms of discrimination. Algorithms have led insurance companies to charge minority communities higher premiums than white communities, for example — even when the risks are the same. Asked how EvolutionIQ mitigates the potential for this sort of bias, Vykruta says that the company invests in “explainability” approaches that make it clear what sort of factors lead to the platform’s decisions.

“EvolutionIQ is not just taking the raw weight from the model. They translate the system that makes sense to [claims adjusters],” Vykruta said. “[The platform is] only showing them [items] that are actionable.”

Risks aside, EvolutionIQ isn’t alone in tackling the opportunity. Among its rivals are CCC Intelligent Solutions, a technology solutions provider for the automotive and insurance industries that relies on data science to expedite claims processing. Riskcovry is another startup in the nascent space, with customers including banks, fintechs and supply chain brands.

EvolutionIQ team

The EvolutionIQ team. Image Credits: EvolutionIQ

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

Vykruta says that EvolutionIQ — which was cash flow-positive in 2021 — will spend the bulk of the new capital on expanding its engineering, data science, product and customer success teams. Customer acquisition will also be a focus going forward, he says, as EvolutionIQ explores new and emerging categories of insurance.