The Role of AI Managing Workers Compensation Claims

In 2018, the National Council on Compensation Insurance published a study that showed over a quarter of all workers comp claims in 2016 were for a value of under $5,000. These types of claims are not really worth an insurance company’s efforts, yet the large number of these claims requires that these carriers spend lots of time on them. People are spending generous resources, time, and money on processing claims that are nowhere near worth all the effort.

The workers comp insurance market is a competitive one, so insurance carriers need to find a way to use their resources wisely in order to stay on top. Fortunately, artificial intelligence (AI) can be a big help. This relatively new technology can sort through claims, saving insurance companies major time and money.

AI machine learning technology can make sense of the date in workers comp claims in order to auto-code and in some cases completely process smaller claims without needing human intervention. As a result, insurers will find themselves with more time for bigger cases, and more resources to take them on.

Claims Management with AI

Machine learning is a fascinating application of AI wherein the system is able to learn from its experience as it runs, and improve on its own without requiring new programming. This AI tool is extremely useful for enhancing back-office efficiency. With machine learning, AI can read, make sense of, and organize information from workers comp claims, even when invoices differ greatly in their layout and format.

The AI is capable of distinguishing between data like address, date of birth, and claims number. It’s also able to note whether a person is insured. In noting these things and organizing data with its mechanical accuracy, AI limits mistakes that are more common from human error, and therefore makes for more accurate claims processing.

For more complicated workers comp claims, the AI can recommend the next step to the examiners. AI does this by pulling up data from similar cases in the past, and suggesting whatever steps were taken by experts in response to those cases. For claims that are not so complicated, AI can carry them through to resolution, possibly allowing for the straight-through processing of over 50% workers comp claims, freeing up major time and resources for insurers.

Other Ways Insurers Can Save Time with AI

AI technology can help insurance carriers stay on top of their management even outside of workers comp claims processing. Some AI technology can be used to provide more personal and accurate underwriting by scanning an individual’s medical history for specific information, rather than using generic, average data.

AI can also track customer response in a number of contexts, allowing insurers to find the balance between digitized customer service and processing, and more personal human involvement when it’s needed.

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