Claims AI investment keeps climbing. Claims performance doesn’t move with it.
80% of claims leakage comes down to four decisions: coverage investigation, scope determination, settlement strategy, and counsel management.
Two experienced adjusters can look at the same file and land in different places on all four. That inconsistency is the actual source of the leakage. The AI sitting on top of it doesn’t touch it.
Most AI investment speeds up the same decisions without fixing them. A bad call that took a week now takes a day. Same leakage, faster.
The carriers pulling ahead rebuilt the decisions themselves: FNOL routed by complexity and severity instead of intake speed, real-time QA on every file instead of after-the-fact sampling, less oversight on the claims adjusters already handle well, and litigation strategy built on outcome data instead of billable hours.
Full framework in the article, link below.
WHITEPAPER
Bridging the Gap Between AI Investment and Claims Performance
Rethinking the AI-Enabled Claims Model
