Claims matter. When it comes to client satisfaction, claims matter most.
You can have the slickest marketing, the best coverage options, even the nicest website, but if a claim drags out, gets denied unfairly, or the process turns into a confusing mess, that’s what the client remembers.
More and more, AI is becoming a difference-maker by eliminating the busy work to complete claims quickly. Here’s how it works and why it matters.
Faster Claims Filing, a Win for Everyone
Traditionally, filing claims involved paperwork, long phone calls, and sometimes office visits. Today, many insurance carriers use digital-first claims-filing platforms with AI doing the heavy lifting.
When a client submits a claim online or through an app, AI instantly:
- Pulls in policy details,
- Confirms coverage eligibility,
- Completes missing info using past data, and
- Provides instant next steps to the client.
Some systems auto-approve simple claims, like a fender bender or minor water damage. There are no waiting days for someone to read through every line of a form; there is just fast and, more importantly, accurate claim processing.
Claim Verification Using Images
Some carriers use computer vision, a fancy term for AI that “looks” at images to verify claims more quickly in health insurance claims. Here’s how it works:
- Physicians upload digital MRI, CT, and X-ray scans to their insurance carrier for a covered patient’s injuries.
- AI scans the images, compares them to thousands of past photos in claims, and quickly verifies the claim’s accuracy and authenticity.
- The triaging of claims takes minutes, and the client completes a preliminary claim process in just minutes.
It’s not perfect yet, but it’s surprisingly accurate for common claim types and always getting smarter.
AI as a Claims Traffic Cop
Behind the scenes, AI evaluates and prioritizes claims like a doctor triages patients in an emergency room. AI models flag:
- High-risk claims that may involve fraud,
- Complex claims needing an adjuster’s personal touch,
- Simple claims that can go straight to fast-track processing
This process helps carriers to allocate resources more effectively, delivering faster and more personalized claims experiences for clients.
Less Fraud, More Accuracy
Nobody likes to talk about fraud, but it’s a real part of the business. AI is getting very good at spotting the red flags associated with fraud. Examples are:
- Repeated claims across multiple carriers,
- Inconsistent story details,
- Staged accident patterns.
AI doesn’t make the final call, as humans still review the work, but AI is excellent at finding needles in the haystack. This work protects honest clients and keeps loss ratios under control.
Don’t Let the Human Element Disappear
AI makes claims faster and more efficiently, but people still want empathy. When someone’s house floods or a car is totaled, the client wants a real person to talk to and listen to.
The key right now is using AI to handle the backend stuff, not to replace the connection to real people who can empathize with clients in difficult situations. AI isn’t a buzzword anymore; it’s a powerful tool that streamlines processing claims and improves turnaround times.
The carriers doing it right are getting noticed by clients for their faster claims processing. According to some estimates, these carriers may also benefit from operational cost savings ranging from 30% to 65%.
The next time you evaluate new partners, consider a technology partner with AI tools that can work quietly in the background to improve your claims process while reducing operational costs. The insurance moment of truth is always the claim, and thanks to AI, that moment is getting the upgrade it deserves.
Agility Holdings Group (AHG) invests in innovative InsurTech, HealthTech, and related companies that aim to revolutionize access to insurance products, establish patient care, and improve health outcomes. Please visit our LinkedIn page for more information.