Claims Talent Spread Thin? No Worries: Digitize Your Claims Triage

With talent spread thin in greying claims departments, insurers are looking to use AI to help digitize their claims triage process and other workflows.

Officially, it’s called “intelligent process automation” (IPA),” a combination of workflow processes, automation and artificial intelligence (AI) or machine learning.

Currently, IPA is able to learn from a company’s processes, rules and claims patterns to direct specific claims to an adjuster who has the most experience, skills or talent in that same area.

“In any organization, there will be adjusters with different skills sets and experience that can handle certain types of claim files more efficiently, depending upon what the injury or claim profile may be,” explains Mathew Raymond, founder of Expeflow, a cloud-based, centrally-administered claims management platform for medical and healthcare claims.

Raymond cites an example drawn from Health Claims for Auto Insurance (HCAI), an electronic system for transmitting auto insurance claim forms between insurers and health care facilities in Ontario.