Emerging Technologies That Streamline Claims

The convergence of AI and human intelligence can streamline claims processing, detect fraud and rewrite the narrative of settlements.

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In an era defined by technological advancements, industries worldwide are harnessing the power of artificial intelligence (AI) to transform and enhance their operations. The insurance sector, known for its extensive web of paperwork and meticulous claims processing, is no exception. As insurers aim to expedite claims approvals and payouts while maintaining accuracy, the spotlight has turned toward emerging technologies.

Amid the buzz surrounding AI, an exploration of its practical applications and limitations becomes vital. To make substantial investments in AI technologies during a time of economic uncertainty, leaders need to be sure that any budget expenditure today can be backed up by tangible ROI in the not-so-distant future.

Looking at processes that have historically been manual and are draining resources is the best place to start when exploring the potential benefits of automation. 

Unveiling the Time-Efficiency Conundrum

Claims professionals invest a staggering 12% of their workdays navigating records retrieval. This totals nearly six weeks every year. Such a burden not only complicates the lives of attorneys, insurance brokers and claims experts but also prolongs the resolution of settlements for those directly affected.

It is against this backdrop that the marriage of insurance and AI has gained momentum as a possible way to reduce fraud, accelerate settlements and revolutionize the industry.

Pioneering Efficient Claims Approvals Through Technology Integration

The journey toward seamless and prompt claims approvals requires both technology and human oversight. Insurers are exploring how emerging technologies can not only reduce processing times but also enhance the accuracy of assessments.

The pivotal role of human oversight cannot be overstated, particularly in quality control. Even as AI streamlines processes, human experts remain integral in guaranteeing the precision and fairness of claims evaluations. By combining the speed of AI with the discernment of human intelligence, insurers forge a path toward efficient yet responsible claims processing.

See also: Embedded Artificial Intelligence (AI) in Financial Services

AI's Investigative Prowess: Countering Fraudulent Claims

One of AI's most lauded capabilities lies in its ability to uncover fraudulent activities that may otherwise evade scrutiny. This is where techniques like medical and social canvassing come into play, acting as deterrents against fraudulent claims by scanning geographic locations for medical treatment and retrieving social information to strengthen cases. 

Innovation within the insurance landscape extends beyond immediate efficiency gains. The rise of generative AI introduces a new dimension to claims processing, possibly transforming medical canvassing, claims assessments and more. As this technology evolves, insurers, lawyers, employers and patients are expected to experience a shift in the way claims are handled.

Navigating the Uncertain Terrain Ahead

In a world where every moment matters in the aftermath of an insurable event, the insurance industry finds itself at a crossroads. The convergence of AI and human intelligence offers the potential to streamline claims processing, detect fraud and rewrite the narrative of settlements. However, this journey must be embarked upon with eyes wide open – acknowledging both the promises and the pitfalls that come with integrating emerging technologies into a domain built on trust and responsibility.

Vince Cole

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Vince Cole

Vince Cole is the CEO of Ontellus, the nation's largest tech-enabled records retrieval and claims intelligence company.

Prior to Ontellus, he served as CEO of Charles Taylor US, a leading provider of claims solutions to the U.S. and global insurance markets. Previously, Cole was CEO, Americas, and global chief strategy officer at Crawford & Company, a claims management solutions business. Before Crawford, he held executive positions at Activa Medical and Genworth Financial. He also spent 10 years at General Electric, serving in senior leadership roles in GE Financial, GE Plastics and GE Capital.

Cole holds a BS degree in engineering from Montana State University.

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