5 Ways Generative AI Will Transform Claims

Generative AI will revolutionize how carriers, third-party administrators and medical management firms operate and the results they can deliver.

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--Generative AI will automate processes, free up time for personalized care, help detect fraud, improve employee morale and make underwriting more accurate.


The launch of generative artificial intelligence (AI) will be a seismic change in how the insurance sector operates, fast-tracking the industry toward intelligent, automated and customer-friendly claims management.  

What’s New About Generative AI and Why It Is So Important 

The first step to harnessing the power of generative AI in insurance is to understand this new capability and how it differs from current AI applications. The insurance sector is most familiar with discriminative AI and its ability to identify and classify patterns in existing data. Generative AI goes beyond organization and pattern recognition. Using deep learning techniques like neural networks, it creates content and conclusions; it not only learns patterns from large datasets but also generates new data that follow those patterns.

See also: 3 Key Uses for Generative AI

The Future With Generative AI

Here are five ways generative AI will transform claims and case management. 

  1. Automating processes and providing answers to questions. Adjusters and nurses spend countless hours reading information, spotting action steps, communicating findings and documenting. With generative AI, this tedious process can be automated. Instead of humans reading, analyzing and updating, the technology can complete the research and analysis and can draft conclusions. Medical documents are summarized, keywords are extracted and issues that need attention are brought to the adjuster’s attention. Generative AI also allows users to query the system via keyboard or voice to get answers to particular questions. 
  2. Transforming customer service and enabling person-centered care. Generative AI will transform the insurer/customer relationship in three ways:
    • Because adjusters and case managers will spend much less time analyzing and processing information, they will have more time with their customers, listening to and responding to their needs.
    • As adjusters and case managers focus more on patients and customers, this personal attention adds the “human touch” to an impersonal and confusing process.  People now expect higher personal regard and customer service in all transactions; this new type of experience meets those rising expectations for the insurance sector 
    • Generative AI provides intelligent, automated, up-to-date information to customers or injured workers at their convenience and from multiple devices. Intelligent chatbots can “think” through a conversation and respond appropriately as questions evolve. This capability provides the instant, accurate information that customers today have come to expect. 
  3. Detecting fraud. Just as generative AI can identify potential problems in a developing claim or case, it can also spot anomalies that might indicate fraud. These danger signs can include excessive use of medical resources, inconsistent injury complaints or lengthy recovery periods with slight improvement. Generative AI can also find information about previous events or claims, incidents and pre-existing conditions that might lead to questions about a claim’s legitimacy. Adjusters, fraud investigators, healthcare providers and other stakeholders can then look further to determine what is going on. 
  4. Increasing employee satisfaction. When insurance employees can spend less time handling objective, repeatable administrative tasks and more time on the people aspects of their jobs, job satisfaction will increase.  Re-engineering these jobs will lead to higher satisfaction, more attractive career paths for recruits and retention of valued employees.  
  5. Lowering risk. Third-party administrators and their customers will achieve a significantly greater understanding of risk factors with generative AI algorithms. As a result, they can develop more accurate underwriting models and strategies for claims mitigation. They can then more accurately price insurance policies and reduce the risk of losses due to inadequate premiums. Conversely, they can avoid overcompensating for risk factors. 

The improvements powered by generative AI will transform claims management and the insurance world, revolutionizing how carriers, third-party administrators and medical management firms operate and the results they can deliver. 

In this new world, time-consuming, manual tasks are eliminated, information is automatically analyzed and presented with action steps and all stakeholders can interact with a humanized intelligence that makes the process easier and more personalized. All participants will benefit from higher efficiency and accuracy, reduced costs, improved employee retention and better customer service.

Jeff Gurtcheff

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Jeff Gurtcheff

Jeff Gurtcheff is the vice president of enterprise comp services at CorVel and the author of the white paper, "Generative AI Is Rapidly Transforming the Claims Landscape."

He joined CorVel in 2019 as vice president of national accounts and strategic insights, providing executive strategic consulting by identifying areas of opportunity based on data-driven analytics. He has more than 30 years of experience in the industry. His background spans the third-party administrator space, independent insurance and the carrier market.

Gurtcheff received his bachelors of business administration/finance from the University of Iowa.

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