Tag Archives: claims processing

5 Things to Know When Integrating AI

In my 30 years in the industry, I have seen several great advances in claims processing, but nothing as exciting as AI. 

The benefits of applying AI can be transformational, not only when it comes to cost control and claims acceleration, but also in providing an exceptional customer experience. 

Several players are promoting AI technologies now — whether it’s for auto or property, underwriting or claims – which means it’s important for claims professionals to be able to see past the AI buzzwords and evaluate solutions against solid criteria. 

According to MIT Technology Review, 40% of AI companies don’t actually have operational AI to apply. As a result, it can be challenging to see which provider actually has a functioning solution, versus one that aspires to do the work in time. 

Here’s my recommendations of what to look for when evaluating an AI platform for claims processing — is the AI making predictions that drive business value or are they just nice-to-haves?

1. When the AI processes photos it has never seen before, does it make accurate predictions? 

An effective AI system can provide a recommendation in real time on a photo it’s never seen before. A quick way to weed out potential providers is to ask for a live demo and submit your own pictures. Grab random pictures from Google or from your own historical claims to really test the waters. Did the AI accept the image? How long did it take to process? What was the confidence of the recommendation? Most importantly, is the vendor comfortable with the approach or coming up with an excuse to dodge this particular exercise? These results will separate a seasoned AI platform from ones that are closer to beta. 

2. How accurate are the results against my existing data? 

Now that you have seen if the AI works – you have to grade it against your historical figures. Ask for a calibration period where you send past photos from your own operations and ask for the AI’s recommendations. Use this as a “report card” to grade the accuracy of the technology. 

3. Do you have an open platform in which to deploy your AI? 

An open platform is more advantageous now and in the future. It allows for flexibility and will make scaling easy by adding, upgrading or swapping in the best vendors and their software for your organization. An open ecosystem also helps in reducing cost by avoiding vendor lock-in and increasing competition to get the best technology out there. The ability to integrate technology with your existing stack and processes will enable each system to “speak” to each other and give a greater picture of your claims operations. Examples of open claims platforms include MitchellGuidewire and Duck Creek. If your claims management system is home-grown, it is also an open platform. 

See also: How AI Can Tackle Claims Staffing Gap

4. Will the AI be adopted by the end-user? 

While the concept of AI can sound daunting to those on the ground, they should see the value that will enable them to focus on other duties and be much more efficient. A good AI provider should be easy to use, with a seamless implementation process across regions. 

5. How will my customers benefit? 

Submitting a claim is already stressful for your policyholders – not including the possibility of being without a car for weeks, or even months. A core key performance indicator (KPI) when evaluating an AI solution is, “How soon can my customer submit a claim?” Be sure to ask how an AI can benefit the customer experience. The concept of generating an instant claim shouldn’t be far-fetched – insurers are already doing it.

3 Techs to Personalize Claims Processing

Claims is a people business – virtually every claims executive I have ever met believes this. If you have ever been in a vehicle accident, experienced damage to your home or business, or been injured in a work-related incident, one of the first things that comes to mind is: I need to talk to someone who can assure me that I have insurance coverage and that there will be resources, both financial and technical, to make me whole again. This reaction is a human one and is not likely to go away. Many claims organizations have tried to maintain staffing levels to ensure a human connection is available to all. However, this is expensive, and claims organizations are already experiencing a shortage of individuals to fill critical claims roles.

Claims executives are at a crossroads, and many questions arise. How do we maintain 1:1 people interactions and simultaneously manage skills gaps and expenses? Then there are digital expectations from all parties to the claim – insureds, claimants, distributors, service providers – how are those expectations met? Given all these weighty challenges, many claims decision-makers relate to the phrase: “There’s a light at the end of the tunnel, and it’s a train coming the other way.” But, for many claims organizations, the reality is that the digital train that is coming can provide answers to the people challenges they face.

See also: How Work Culture Affects Claims Process  

SMA’s recent research report, Claims Transformation: New Paths Forward for Reporting,  Verification and Communications, explores emerging technologies and trends in claims operations. Relative to the people business theme, there are several areas of innovation where concerns, expectations and answers merge.

  • Self-reporting via photo and video. Apps that facilitate the insured or claimant in providing visual representation of damage will speed the claim along versus waiting for an adjustor or inspector to do the same thing. Faster settlement clearly meets consumer expectations. Additionally, precious claims resources are preserved for more complex claims.
  • Self-reported photos and videos along with AI analysis. The resulting outcomes from AI analysis can facilitate the next-generation of straight through processing (STP), ultimately going well past the current glass and towing claims STP, as things such as machine learning evolve over time. Again, shorter time to settlement with little or no claims adjustor involvement – a win-win.
  • Telemedicine and digital health platforms blend consumer-accessed, personalized information with a collaborative environment for adjustors, service providers, medical professionals and other concerned parties. These technologies blend useful, self-service information with human access at the moment of need.

These are just a few examples of the technologies that claims organizations have at their disposal to transform processes and operations. The previously mentioned SMA research report covers many other areas.

Make no mistake, balancing when to insert adjustors into processes and when technology can facilitate desired outcomes is not easy to accomplish. One of the key success factors is to look at claims processes from the outside in. This is not intuitive for claims organizations that have spent entire careers managing the challenges and intricacies of the adjustment process with an internal lens to meet corporate compliance goals and tangential department needs within a regulatory framework that can be daunting.  However, looking at claims processes from the consumer perspective – outside in – can suggest ways of execution that fulfill the need for the customer to be compensated for their loss in the fastest way possible or to find the clearest path to wellness. Happily, these outcomes also preserve human claims resources for when an individual really needs it.

See also: The Best Workers’ Comp Claims Teams  

The technology vs. human paradigm will continue to change, probably forever. However, claims is one of the areas within insurance where expert adjustor skills can truly make a meaningful difference for individual outcomes. But the definitions will continue to change, and the challenge for claims executives will be to continually assess processes through a different lens. Optimistically, the light in the tunnel will be a source of inspiration.