How AI is Helping Claims Adjusters Become More Efficient

By October 21, 2019 October 31st, 2019 AI, Blogs, General
claims ai

Insurance claims adjusters face a lot of challenges as they execute their responsibilities for verifying and accurately documenting the claims. The experienced ones are often over-burdened with the caseload, making the settlement cycle longer. Such delays could lead to dissatisfaction among customers. On the other hand, some claims adjusters have a lighter load and would have been able to clear more claims cases had they been assigned to them.

Claims adjusters have to check the authenticity of each claim to ensure that there is no fraud. After all, fraud is one of the biggest drains on the revenue of an insurance company. Often, the authentication process requires a long and detailed investigation, which further delays the claims settlement process.

The key to reducing cycle times is to identify the claims cases that can be settled with historical data and establish patterns that can determine STP (Straight-Through Processing) cases. This way, only the claims that need authentication to get passed on to the claims adjusters and their expertise is utilized more effectively. AI-driven claims settlement solutions offer many advantages and can help claims adjusters be more efficient.

Better classification of claims: Identifying and assigning claims is where an AI-driven claims settlement solution can help tremendously. An AI solution designed with advanced machine learning capabilities can get trained on insurance claims data and help speed up the claims settlement process. The algorithms can help sort complex cases and assign them to adjusters who have matching expertise. By analyzing the patterns from the historical data, an AI-powered claims solution allows for faster authentication, leading to the payout of genuine claims without delay.

Better fraud detention due to central access to all relevant incident data: Claims adjusters are always looking to establish the validity of the claim quickly. With all the incident data available centrally, claims adjusters are able to make the right calls quickly and with increased accuracy. Deep learning capabilities of the solution bring together all the pertinent incident data to one place. This action allows claims adjusters to choose the claims that need investigation and those that need to be deferred to the SIU (Special Investigative Unit). Better fraud detection also directly results in an improved loss ratio.

Better customer experience due to faster settlements and accurate estimates: With faster and more accurate claims processing, cycle times become shorter. Claims adjusters can use predictive insights for faster closure of genuine claims. This ability leads to a reduction in expenses, which, in turn, delivers better NPS (Net Promoter Score) for the insurers. Better customer experience also leads to better customer retention.

With AI claims solution, claim adjusters can also help identify patterns from data to catch repeat offenders and fraud networks.

Settling insurance claims is a complex process, and claims adjusters are a vital part of it. They are responsible for authenticating the claims and make sense of all the incident data to arrive at an estimate. They are overworked and under a lot of pressure to settle claims quickly. At the same time, they have to ensure that no fraudulent claims are paid out. AI-enabled claims settlement solutions can make their job easier and help them streamline their claims caseloads.

Leave a Reply