How AI is Transforming the Insurance Claims Experience

When it comes to managing insurance claims, organizations that insure their own risks are in a delicate but notably advantageous spot.

These self-insured organizations bear direct financial responsibility for every insurance claim. While some might see this as a burden, the upside is that self-insured organizations are uniquely positioned to proactively manage and potentially reduce risk.

And that advantage increases with the use of AI.

Traditionally, claims processes have been manual, time-consuming, and error-prone, leading to claims resolution delays, higher costs, and a reactive approach to risk management.  However, the integration of AI is fundamentally changing this landscape.

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AI-powered systems using intelligent document processing (IDP) can now ingest and analyze vast amounts of unstructured data from medical records, invoices, and claim forms in seconds versus weeks. IDP allows for instant triage of documents, automated fraud detection, and predictive analytics that can forecast the severity of claims filed.

By automating these core functions, AI not only drastically reduces administrative overhead and “leakage” (overpayments), but also empowers claims professionals to focus their expertise on the most complex cases, ultimately leading to faster, more accurate decisions.

Staying ahead of risks through data-driven insights

For these reasons, the impact of AI on self-insured organizations represents a paradigm shift from reactive claims handling to proactive risk management.

By using AI-driven insights, organizations can gain a comprehensive understanding of their claims data to identify trends, pinpoint high-risk areas, and implement targeted safety and prevention programs.

For example, when a large retailer in Australia analyzed its claims history, managers identified a pattern and adjusted their cleaning schedule to reduce the number of slip-and-fall injuries. This data-driven approach facilitates better allocation of resources and, crucially, improves outcomes for injured employees by enabling faster return-to-work and more personalized care plans.

Organizations have also begun to use contributory databases to better estimate the future costs of insurance claims and to set appropriate reserves. Leaders are using data to help estimate when employees are likely to return-to-work as well as gauge supplemental health concerns. Their ability to make consistent, objective decisions based on real-time data enhances the employee experience and builds workplace trust.

Using AI to empower claims professionals and workforce 

Ultimately, AI transforms claims management from a cost center into a strategic asset, providing self-insured organizations with unprecedented control, operational efficiency and a clear path to building a safer, more resilient workforce.

For instance, claims advisors can use AI-powered sentiment analysis tools to generate call summaries, recommend the next best actions and escalate calls that need extra attention. These tools provide real-time assistance so claims professionals can give their full attention while routine tasks are handled automatically.

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Deciding which AI tools work best for the workforce

The availability of AI tools today is vast, covering a wide range of industries, functions and use cases – and this number will only grow as AI becomes increasingly sophisticated.

For example, DXC has worked on a generative AI solution called Assure Answers that helps digest voluminous and complex user documentation. For years, user guides, claims handling guidelines and regulatory specifications have sat in hard copy— and rarely read. With Assure Answers, companies can digitize this documentation and make it instantly accessible through a generative AI interface.

As AI continues to evolve, organizations that stay curious and explore emerging capabilities will lead the way in transforming claims management. Because AI has the potential to help reduce the likelihood of certain claims by identifying risks earlier and supporting proactive interventions, those organizations that uncover innovative ways to apply this technology will unlock new levels of efficiency and creativity across their operations.