By Tom Warden, Research Fellow, CLARA Analytics
Claim adjusters work under stressful circumstances. They are responsible for managing upward of 200 claims at a time. Some of these claims are simple and straightforward, while others, especially those involving significant injuries to the claimants, can contain hundreds of documents of many types and have multiple doctors, nurses and attorneys involved. Complex claims like these can take years to settle and cost the insurance carrier millions of dollars each.
Claim adjusters are measured and evaluated on many quantitative aspects of their job, adding to their stress. Adjuster actions must be executed swiftly, with claims settled and closed in as little time as possible — and as inexpensively as possible. The adjuster must do all this while being compliant with state laws and regulations about appropriate claim handling and also delivering top-notch customer service to claimants and policyholders.
AI tools help adjusters by identifying which claims need immediate attention when new information is received. With so many open claims, an adjuster is likely not to see documents and bills received for each claim every day. Some of them are routine, but others can signify a change in the claims severity and complexity which requires immediate action. AI tools can alert the adjuster daily to claims that need attention. AI tools can also automatically project the expected future path of a claim based on known and new information. This enables the adjuster to respond with the most appropriate action more often. AI tools can also help an adjuster create the best treatment plan for an injured party. Some vendors assess the past performance of physicians and medical clinics from vast data sets of prior claims. They can identify things like which physician located near the injured party is likely to provide the best care and a positive outcome for recovery.
While many workers fear that AI tools will replace them, AI’s best use in claims is to arm the adjuster with superpowers that enable them to work more efficiently and effectively.
About Tom Warden
Tom Warden, Research Fellow at CLARA Analytics, is an experienced leader in using data, analytics and AI to solve complex business problems. As a Chartered Financial Analyst with experience in securities analysis and portfolio management, Warden focuses on identifying and optimizing what creates value and what destroys it within companies.