Automated Claims Processing
Description
The purpose of the AI is to automate aspects of NCA benefits and application processing to decrease the case processing time and increase the customer service delivered to Veterans and their next of kin. Currently, it is applicable to the Pre-Need and Presidential Memorial Certificate programs. In the future, other business lines may be included, such as the Headstones, Markers, Medallions, and Urns and Plaques programs. This benefits NCA by automating aspects of the workload (data entry, case creation, document digitization, letter creation, and status updates).
Detailed example
The Hyperscience platform (optical character recognition (OCR), natural language processing (NLP), and machine learning (ML)) extracts document data, uses application programming interfaces (APIs) to query data from other VA systems, and applies robotic process automation (RPA) to enter data into existing legacy NCA systems: Eligibility Office Automation System and Web Presidential Memorial Certificates. As the case is processed, automation creates documents that combine relevant claimant information (for use by claim agents), updates statuses, and creates letters, as appropriate. No original content is created through these processes.
AI / analytics pattern
Natural Language Processing: AI that processes, interprets, and shares information in human language.
Automation level / stage
c) Deployed – The use case is being actively authorized or utilized to support the functions or mission of an agency.
Expected benefit
The outcomes support expedited service delivery of benefits to Veterans and their next of kin. About 30% of Veteran applicants receive their Pre-Need eligibility determinations within 24 hours, without human intervention.
Controls / human review
ATO: Not reported; PIA: Not published