Using AI to Provide a More Human Claims Experience

The robots are coming—and in some cases, they’re here.

Advancements in generative artificial intelligence are enhancing claims processes in many ways, from improving First Notices of Loss (FNOLs) to analyzing videos and images to assessing damage quickly.

With all of these changes, some may ask: How long until GenAI replaces adjustors and other claims professionals?

The short answer is: It won’t be anytime soon.

Those who think claims professionals can be replaced with GenAI are not considering the critical role people play in delivering an empathetic claims experience, which is what customers require after experiencing a catastrophic event. And with catastrophic events getting more frequent and severe—empathy is at a premium.

According to Swiss Re Institute, global insured losses from natural catastrophes in 2023 exceeded USD $100 billion for the fourth consecutive year. The institute also estimates that insured losses could double within the next 10 years as temperatures rise and extreme weather events become more frequent and intense. This season, we have seen Hurricane Beryl become the earliest category 5 hurricane and Hurricane Debby brought record rainfall. And the season is ramping up. The National Oceanic and Atmospheric Administration issued in August its mid-season hurricane outlook, which predicted 17 to 24 named storms, of which eight to 13 could become hurricanes.

While empathy is vital during the claims experience after catastrophic events, claims teams’ abilities to respond quickly with empathy is often strained due to the volume of submissions and the amount of communications from claimants. After Hurricane Debby, Florida insurers received nearly 12,000 claims, according to data from the State Office of Insurance Regulation.

But by utilizing GenAI tools, claims professionals can boost their capacity for empathy. These solutions can alleviate workloads, enabling claims teams to spend the extra time answering claimant questions and reassuring them they will come out on the other side. They can help bridge the talent gap as claims professionals often have large workloads and not enough adjustor talent. Claims teams should not see AI solutions as threats to their jobs but as enablers of providing human connection.

Finding the Right Balance

One of the best opportunities for AI automation relates to processes that don’t interface directly with claimants. For example, automated claims triaging tools can ingest data from FNOLs, photos and reports, review submissions for severity and complexity, and route them to the right adjustors. This not only enables the insurer to make sure adjustors are prioritizing the most severe damage, but it allows the company to balance the adjustor’s workload so they have enough bandwidth to provide the appropriate level of service to their claimants.

When insurers look to incorporate AI solutions into customer facing processes, they need to be cognizant of claimants’ receptivity to interacting with AI and where they would prefer to deal with a human. Chatbots and AI voice assistants can be great tools for managing inbound calls following a catastrophic event, providing insureds with basic information such as policy and coverage information. This can eliminate long wait times for simple questions. But insureds with more complex issues want to speak with a human. By utilizing chatbots and AI voice assistants for routine tasks, insurers can alleviate the call volume and minimize wait times for those who need to speak with a claims professional.

Managing the Day to Day

Communicating with claimants is an important role for claims adjustors. But managing these communications is a time intensive activity that can take away from other important tasks. Claims management systems with AI and machine learning capabilities can help adjustors balance communications workloads. These platforms can automatically respond to routine emails. They can summarize adjustors’ notes and send this information to claimants. With these systems, automatic emails can easily be customized, so claimants do not feel like they are receiving a generic response or an automated reply.

GenAI powered sentiment analysis solutions can review customer communications to detect tone and urgency and recommend next steps the adjustor needs to take. Sentiment analysis can also help prioritize communications that may look like regular requests but need special handling. Consider a simple status update request an adjustor receives. Sentiment analysis might detect an elevated level of concern and frustration in the consumer’s note. Rather than an automated note, the analysis could trigger a call from the adjustor.

Claims processing tools with AI capabilities can also help adjustors speed up document processing by ingesting documents, images, videos and other data and quickly analyzing and summarizing them. These tools also enable adjustors to be more organized, tracking assessments and decisions.

Human Touch Doesn’t Need to Be in-Person

While claimants want the ability to interact with their claims teams, it doesn’t have to be in-person. Many insureds are open to working with technology, as long as they know they have the option to speak to a person.

Virtual adjusting solutions can expedite the claims process significantly. Instead of waiting for an adjustor to visit a property, claimants can use their own phones to capture the damage through videos and images. The information is then submitted to the claims team. Virtual adjusting solutions can do an initial assessment of the damage which is then share with the adjustor to complete the estimate.

When incorporating AI solutions into their claims processes, it’s important for insurers to have support from the top. Good leaders communicate with their claims teams, alleviate any misgivings they have about AI, and reiterate how it will enable them to give a better human experience to their customers.

It may seem counter-intuitive. Using technology can provide a more human, and personal, experience for insureds during the claims process. GenAI solutions can make it easier for claims professionals to provide human interaction. Technology automates simple and routines tasks, reducing claims workloads giving them more time to personally interact with claimants. And technology also enables quick and customized responses, setting the claims teams, insurers and customers up for success.

Rothchild is senior vice president, head of Claims at Xceedance. He leads the claims business at Xceedance, and has 20 years of operations and technology leadership experience across the insurance, software and supply chain distribution industries.

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