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How is AI Used in Claims Management?
When insurers think of innovation and improving insurance processes, claims often come to mind. They’re the moment of truth in insurance: where trust is earned, yes, but also where costs can pile up, and inefficiencies quietly drain resources.
Insurance claims automation has already reshaped how insurers handle this make-or-break moment. But throw in artificial intelligence (AI), and suddenly, you’re not just saving time; you’re making smarter decisions, reducing leakage, catching fraud, and improving customer loyalty.
This article focuses on how generative AI in insurance is transforming claims management from a slow, manual headache to an even sleeker, more efficient, and data-driven operation than standard digital claims technology can offer. For a deeper look at the bigger picture, check out AI in claims processing and related resources.
Let’s get into how it all actually works:
How do you automate claims processing?
Automated claims processing means removing as much manual effort as possible from the lifecycle of a claim — from first notice of loss (FNOL) through final settlement. Think digital intake, automated workflows that can provide almost instant validation, pre-set rules, and straight-through processing for run-of-the-mill, non-fradulent claims.
Insurers using EIS automate claims by embedding rules-based workflows within a modern, cloud-native system. This isn’t just about speed — it’s about precision. Claims get routed to the right adjuster (if needed), flagged for risks, or even settled instantly if the data checks out.
And we’re not just talking about saving time (and therefore cost) on the backend: smart automation can cut costs, reduce errors, and boost customer satisfaction. In fact, according to EY, 87% of policyholders say the claims experience affects whether they stay with their insurer
How is AI used in claims management?
AI in insurance claims processing, when applied well, can act as the brains behind the operation. It enhances automation by making real-time decisions based on data patterns, probabilities, and learned behaviors. And unlike hard-coded rules, AI adapts.
Here’s what AI is doing under the hood:
Scanning documents with NLP to understand incident descriptions
Comparing new claims to thousands of historical ones to predict outcomes
Assessing risk and identifying signs of fraud before a human ever touches the claim
This doesn’t mean AI is replacing people — it’s augmenting their ability to act faster and smarter. (More on that “Will AI replace claims adjusters?” question later.)
How can AI be used in claims processing?
Great question. AI in insurance claims processing can be used for several purposes:
- Triage: AI assigns incoming claims to the right track — straight-through processing or manual review.
- Risk scoring: Tools like EIS ClaimGuard assess claims in real time for potential fraud or complexity.
- Predictive analytics: Machine learning models forecast claim costs and durations based on past patterns.
- Conversational AI: Chatbots handle status updates and FAQs, reducing the burden on contact centers.
These use cases are already deployed at scale with EIS clients. One insurer reduced LAE significantly using AI to pre-score and segment claims — fewer wasted touches, more precise outcomes
What is generative AI for claims processing?
Here’s where it gets particularly exciting and time-efficient.
Generative AI in insurance uses large language models (LLMs) to generate human-like responses, summarize claim details, and streamline documentation. It’s not just about ingesting and understanding data; it’s about communicating it.
Imagine this: A customer submits a photo and a brief note. GenAI drafts a full claim summary, flags missing data, and suggests next steps, all before your adjuster logs in.
In the world of AI in insurance claims, generative AI is the new co-pilot — like a very hand, very fast, error-resistant assistant for all claims adjusters. It doesn’t just speed things up. It brings consistency, reduces burnout, and even improves compliance by suggesting policy-aligned actions.
Will AI replace claims adjusters?
No. But it will change the job.
AI will handle the routine stuff: document parsing, early fraud detection, standard settlements. Human adjusters will oversee the routine stuff and spend more of their time handling the fringe cases — the nuanced, high-touch, emotionally complex claims that require empathy and judgment.
So, no, the robots aren’t taking over. They’ll just make it so fewer people have to do mind-numbing copy-paste work, and enable them to do what they’re actually good at: thinking critically, resolving tough cases, and building trust.
AI Claims Solutions
If you’re looking for AI claims solutions to implement, the best ones do more than just automate — they make every part of the claims journey smarter, faster, and more human-friendly.
EIS offers AI-powered solutions like ClaimSmart, a suite that includes:
- ClaimPulse: Provides real-time claim tracking and personalized updates to customers — cutting down on the “where’s my claim?” calls.
- ClaimGuard: Uses AI to detect fraud and assess risk, scoring claims continuously throughout their lifecycle.
Better yet, ClaimSmart works on top of any core system — whether you’re running cutting-edge cloud-native tech like EIS, a modern legacy system, or still holding on to a legacy platform. It’s built to integrate and deliver value without needing a full rip-and-replace.
Want to see it in action? Check out how one insurer used this setup to cut loss adjustment expenses. Hint: It wasn’t by hiring more people or adding more spreadsheets. 😉
AI is Changing Insurance Claims. Are You In?
AI in claims handling is no longer a “someday” conversation. It’s here. Right now. And insurers who lean into it are seeing real results — fewer delays, less leakage, and happier policyholders.
EIS brings it all together with AI claims solutions that don’t just automate claims — they make them easier for everyone. ClaimSmart, ClaimPulse, and ClaimGuard work in sync to deliver smart automation, proactive risk assessment, and seamless digital experiences. (By the way, ClaimGuard was named a technology standout by Celent — not too shabby.)
Ready to turn your claims process into a strategic advantage? Explore EIS claims solutions.