Top Five Questions Claims Executives Have About Generative AI

GenAI's transformative power holds promise for insurance, offering substantial benefits to claims organizations through responsible implementation.

Generative AI (GenAI) represents an emerging capability with substantial potential to transform processes and workflows across the insurance industry. Claims organizations may see significant benefits from the responsible implementation of GenAI techniques.

The Datos Insights report, Top Five Questions Claims Executives Have About Generative AI, discusses what GenAI can do for claims today and in the future, what it can’t do for claims, the regulatory concerns associated with using GenAI in claims, and how to help your organization adapt to the changing claims landscape. Here are some key takeaways from this report.

GenAI Could Transform Claims Processes and Operations

One key capability of GenAI is the ability to rapidly ingest and summarize large, dense documents like medical records, legal briefs, police reports, and other claims documentation. Rather than requiring adjusters to review hundreds of pages manually, GenAI can provide concise summaries of key information. This can significantly accelerate claims assessment and resolution.

Implementing GenAI can accelerate time to value because GenAI requires less IT lift than other new technologies, especially if carriers leverage knowledgeable vendors. GenAI can integrate with existing tools and processes vs. requiring the development of new platforms or full process redesigns.

Limitations on the Use of GenAI in Claims

As powerful as it is, GenAI does not eliminate the need for human expertise, discretion, and empathy in the claims process. For example, carriers should apply GenAI cautiously, if at all, for life insurance claims involving the death of a policyholder. These claims’ sensitivity and emotional nature require an empathetic, human approach. Virtual assistants or other GenAI interactions could be perceived as impersonal and inappropriate.

More generally, GenAI can provide information to support claims assessment but cannot make final decisions on coverage or payment amounts. Those determinations require a licensed claims professional.

Adopting GenAI Is an Iterative Process

As new technologies like GenAI transform claims processes, insurance leaders play a key role in guiding their organizations through adapting to new practices. Insurers must balance enabling cutting-edge capabilities while ensuring that claim outcomes, especially loss costs, don’t erode.

Adjusters have tremendous expertise, which, when coupled with a thoughtful change management strategy, claims organizations can use to improve continuously and extend how AI makes experts more effective and the process more customer-centric. Insurers should modify legacy claims workflows and organization to maximize benefits from AI augmentation. This adaptive approach enables people and AI systems to work synergistically.

GenAI Is Powerful but Will Require Considered Action in Claims

GenAI has the potential to improve claims processes and increase efficiencies, especially for adjusters. However, claims is a domain where many tasks are not appropriate for GenAI, so careful governance and change management will be especially important to ensure the thoughtful integration of GenAI into appropriate tasks.

To read the full report on this topic, see Datos Insights’ report Top Five Questions Claims Executives Have About Generative AI.