AI and claims

Insurance claims professionals are no strangers to disruptive technologies. Over the next several years, artificial intelligence (AI) is expected to be among the most disruptive technologies for digitally-enabled businesses in general, and for claims organizations in particular. However, there is disagreement about what AI can and cannot do, which has understandably led to some confusion about how claims organizations should use it.

AI that Works

The claims profession is positioned to benefit most from AI in two primary ways:

This is because, while AI is not capable of taking over completely for highly-skilled workers, it can be leveraged to lighten the burden of mundane tasks, and to help improve efficiency and outcomes. To deliver these advantages, Wolters Kluwer’s ELM Solutions has introduced LegalVIEW® BillAnalyzer, a service offering that combines AI technology with expert legal bill analysts to streamline bill review while increasing billing guideline compliance.

Within a claims organization, AI can be leveraged for keeping spend in check, simplifying workflows, and improving customer service. For example, some use AI in their “touchless” approach automating the claims process, enabling carriers to improve quality and limit processing time. The opportunity for claims organizations to benefit is significant because they collect such a large amount of data.

However, when you decide to begin using AI, it is critical to leverage it in the way that truly works best for your organization and policyholders. The considerable “buzz” around AI has made some companies so eager to begin using the technology that they may implement it in ways that are not actually helpful to clients. Industry analyst Gartner recommends asking vendors to provide a proof of concept that demonstrates exactly how their solution can improve your bill review performance.

Demonstrating Results

At Wolters Kluwer’s ELM Solutions, we agree so wholeheartedly with this advice that we offer a free POC analysis and report to companies that are curious about whether BillAnalyzer would benefit them. We process your recent historical legal billing data and use machine learning to compare line items against your billing guidelines. Our invoice analysts then refer to that information and note all the adjustments they would have taken on those invoices. The result shows the compliance issues and additional savings that BillAnalyzer would have identified on those invoices.

Since we launched BillAnalyzer, dozens of companies have requested POC reports. The findings are striking. On average, most companies are taking adjustments of 3-3.5% with a traditional bill review approach, while POC results average 7-15% adjustments. That’s 2-5 times the savings of traditional bill review for most companies. In addition, this represents increased compliance with the billing guidelines that outside counsel have already agreed to.

To understand the wider context and benefits of AI-enriched claims litigation software, download our white paper The Role of Artificial Intelligence in Claims Litigation, which includes more about what AI is and how it can improve your claims operations.


About The Author

Vince Venturella

Vince is the product manager responsible for the development of Wolters Kluwer's ELM Solutions insurance market offerings for claims and staff counsel. Vince is a strategic, results-oriented legal technology leader with a consistent record of improving processes, developing innovative solutions, and leading diverse product teams. He has worked in legal management consulting and technology solutions within the insurance market for almost a decade. Vince is a graduate of The Ohio State University in Columbus, Ohio.