For claims, insurers are using AI more for checking information and improving processing than for denials, industry executives say.
Adoption of AI for claims processing has been slow, but is starting to pick up, they add.
Insurers are augmenting claims workflows with AI, according to Chris Raimondo, EY Americas insurance consulting leader. AI assistance for insurance agents, or
The key for insurers deploying AI for claims is their error tolerance, Raimondo added. "In the financial adjudication of a claim, tolerance for error or inaccuracy is a high bar," he said. "Where we're at today is setting parameters in the AI models that allow for human interaction and intervention while they're still in process, rather than at a final decision or final outcome."
Insurers can use AI to automatically adjudicate simpler claims, leaving management of more complex losses to human adjusters, according to Carla Woodard, SVP of claims at Pie Insurance. "The human aspect is absolutely necessary," she said. "What we're doing is assisting our human experts to focus on the things that really do make a difference and provide that human touch."
With property and casualty (P&C) claims, insurers are using AI to detect fraud, in the form of pictures of damage or loss allegedly altered with AI, according to Suzanne Grover, VP of underwriting at Coastal Wealth, a wealth management solutions provider. "Insurance claims departments are starting to use AI earlier, especially for fraud protection, trying to find these aberrations in data more quickly, so we can mitigate the fraud aspect," she said.
Requiring policyholders to provide more evidence on a routine claim, instead of fast-tracking it to payment, can have consequences, according to Manjit Rama, executive vice president of insurance at Clearspeed, a voice analytics company serving insurers' claims operations.
"If we ask you if you have exaggerated the claim, even if you say no, and we accurately assess that, there is a risk there," he said. "Why are we asking you for evidence? Let's fast track you through to payment because it's great customer service. You've been paying all these years, and now you file a claim – you don't want to feel like I don't trust you. If you give the impression to people that you don't trust them, they will bounce back at you by doing things like exaggerating claims."
