Santéclair: Detecting Fraudulent Claims More Effectively
Santéclair uses Dataiku to enable fraud detection teams to target actual fraud cases 3x more effectively, saving money for both the company and its customers.
Mehr ErfahrenMalakoff Humanis is the #1 non-profit group health insurer in France. It offers supplementary health, welfare, and pension contracts to companies and employees, self-employed and single-payer individuals. As a complementary health insurance, the mutual fund covers healthcare reimbursements in addition to the French social security, and guides clients in their choice of care establishments. It counts:
Malakoff Humanis has a dedicated data science and analytics department led by a Chief Data Officer. The data department is comprised of four main branches, each in charge of:
To address their growing challenges in keeping up with customer demands and providing quality customer service, Malakoff Humanis turned to Dataiku’s Deep Belief program, which provides consulting services to tackle ambitious AI projects. Through this program, Malakoff Humanis collaborated with Dataiku’s data scientists on two advanced natural language processing (NLP) projects.
Initially, Malakoff Humanis started working with Dataiku on an AI-based solution that helps understand the topic of online claims through NLP classification algorithms and automatically dispatch the claim to the appropriate customer service team.
The developed model served as a foundation for building and implementing another solution for improving telephone customer assistance through NLP, which today is fully operationalized and widely used across the customer service department. The initial project helped prove the benefits of using a centralized Enterprise AI and data science platform for end-to-end AI, and more specifically NLP-related projects, as well as the value of the reuse and capitalization on data projects.
The purpose of the second AI project that Malakoff Humanis developed using Dataiku’s Deep Belief program was to analyze the content of customer calls (themes and tone) in order to identify areas for improvement of telephone assistance. The main goals of the project were:
The solution is composed of two main modules which answer two main questions:
Even though the object of classification, or the input data, in this second project was different than the first one (telephone call voice recordings as opposed to written online claims), the similarities in terms of topic categories and the NLP classification techniques used allowed for the reuse and repurposing of the classification algorithm built for the first project. This allowed for a significant reduction in the time required to put the model into production.
Thanks to Dataiku, we were able to take an already existing model and seamlessly repurpose and reuse it on a new type of data for a new use case.“
Gauthier Lalande, Lead Manager AI, Malakoff Humanis
The sentiment analysis NLP model built to assess the tone of telephone calls generates predictions for the overall tone, the tone of separate sentences in the conversation, and the sentiment at the beginning and the end of the conversation (20% of the first and last words). In the absence of labeled transcripts for the tone, the predictions were verified empirically.
Finally, a dynamic dashboard was built to present the results of the predictions in real-time and inform decision-making across the data and customer assistance teams.
The project allowed us to deploy a new method of analyzing phone calls thanks to a mixture of AI and business rules that intelligently complement each other. This provided the opportunity for the customer relations team to understand the contributions of AI and for data scientists to incorporate the business area expertise into the model.“
Gauthier Lalande, Lead Manager AI, Malakoff Humanis
Dataiku’s centralized data science platform allowed us to build an end-to-end advanced NLP project, from connecting to data to visualization and analysis. It provided a smooth and secure transition between the exploration and production phase, with extensive documentation which facilitates the transfer, reuse, and capitalization of projects between the different stakeholders.”Gauthier Lalande Lead Manager AI, Malakoff Humanis
Supporting Your Path to Enterprise AI
Dataiku’s Deep Belief program helps Dataiku’s customers implement advanced AI projects and:
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